Atypical drainage of a persistent left vena cava superior into the left atrial appendage detected by multidimensional imaging: a case report and review of the literature

Background While it is the most common thoracic venous anomaly, a persistent left vena cava superior may present in atypical variations, which are important to consider during clinical management. Case presentation Here we report a 35-year-old Caucasian female patient with drainage into the left atrial appendage who presented with shortness of breath accompanied by mild hypoxemia. Venous contrast filling in the context of pulmonary scintigraphy suspected an additional superior caval vein connected to the left atrial appendage. Diagnosis was confirmed by transesophageal echocardiography. Cardiac catheterization revealed a minor right-to-left shunt. The symptoms could be allocated to a bronchial asthma and treated according to guidelines. Cerebral lesions detected in the patient were due to a coincident multiple sclerosis rather than cerebral embolisms. Thus, the venous anomaly was classified as an incidental finding currently requiring no treatment. Conclusions To the best of our knowledge, this is the first report of a persistent left vena cava superior draining into the left atrial appendage.

Clinical report of a patient with primary mediastinal B-large cell lymphoma

Primary mediastinal B-cell lymphoma is a variant of non-Hodgkin's lymphoma with the predominant involvement of mediastinal lymph nodes, which affects young women. Diagnosis of this nosology is difficult due to the rare involvement of peripheral lymph nodes, as well as the rapid increase of clinical manifestations, such as the syndrome of compression of the vena cava superior and the development of the respiratory failure. The article presents a clinical case of a patient who was operated and complications that occurred due to inadequate diagnostic and therapeutic tactics. There aren`t any descriptions of the clinical manifestations of the disease which could led to a diagnostic error in literature. We present our own observation of a patient with PMBCL and discuss a practical diagnostic algorithms for mediastinal tumors. The diagnosis of PMBCL can be established only as a result of morphological examination, it is important that surgeons and pathologists remember about it. This case is important not only because it provides information about such a lymphoproliferative disease as PMBCL, but also reminds about such a diagnostic error in oncology-treatment without verification. We tried to emphasize the nesessary of strict implementation of the algorithm for differential diagnosis of the anterior mediastinal neoplasms, especially for young people. I hope that this case will contribute to the expansion of knowledge and the prevention of errors in order to achieve better results.

Vena cava superior syndrome. Analisis of interventional and medical treatment options

We present a clinical case of a 72-year-old man with a history of hypertension and SARS-CoV-2 infection, urgently hospitalized in the intensive care unit due to dyspnea at rest, blushes and swelling of the neck and face, headache, and syncope. Echocardiography was performed and revealed preserved ejection fraction of left and right ventricle (EF – 57%, TAPSE – 21 mm), without hemodynamically significant valve lesions and normal ECG. On the next day of hospitalization, we performed a computer tomography (CT) scan of the lungs and it showed a tumor in right lung, compressing vena cava superior. Venography was performed and revealed subtotal thrombosis of vena cava superior and stenting with Wallstent 16/60 mm was performed. Six hours after the intervention a clinical improvement was achieved – reducing of the swelling and relieving of the symptoms.

Carcinoide atípico de timo en varón de 39 años: Reporte de caso

El carcinoide atípico (CA) de timo es la neoplasia más agresiva y rara que surge en el mediastino anterior y que pertenece a los tumores primarios neuroendocrinos de timo. La mayoría de los pacientes son asintomáticos y según la extensión de la enfermedad pueden presentar desde tos, disnea, dolor torácico hasta síndrome de vena cava superior. Esta presentación clínica inespecífica disminuye la probabilidad del diagnóstico temprano que, sumado con el estadio avanzado al debut y la imposibilidad de resección quirúrgica reduce la tasa de supervivencia. El objetivo es dar a conocer la presentación clínica, imagenológica y patológica en un varón de 39 años con CA de timo cuyo diagnóstico definitivo se basó en el estudio histopatológico (morfología carcinoide, mitosis 0-1/2 mm2, necrosis, Ki 67 = 12%) y marcadores inmunofenotípicos del tumor (CD 56 (+), Panqueratina (+), Sinaptofisina (+), TTF -1 (-)).

MO1013RETROSPECTIVE ANALYSIS OF THROMBOTIC COMPLICATIONS IN SHIGA-TOXIN ASSOCIATED HEMOLYTIC UREMIC SYNDROME IN CHILDREN

Background and Aims Shiga-toxin associated hemolytic-uremic syndrome (STEC-HUS) is a thrombotic microangiopathy (TMA) followed by intestinal infection caused by shiga-toxin-producing E. coli. Endothelium damage of the microvasculature leads to the formation of platelet-fibrin thrombi and occlusion of small vessels. The aim of our study was a retrospective analysis of thrombotic complications in children with STEC-HUS. Method We retrospectively analyzed the case histories of patients in the dialysis department of St. Vladimir's Children's City Clinical Hospital from 2009 to 2019. The study included patients with STEC-HUS with the development of thrombotic complications. Results Among 410 patients with STEC-HUS, 16 patients with thrombotic complications were identified. Equally boys and girls, mean age 3.5 ± 2.4 g. Respiratory support was required in 6 cases. The duration of anuria was 9.9 +/- 6.2 days, in 2 cases only oliguria was noted. In all patients blood transfusion, fresh frozen plasma were needed, antibiotics were used. In all cases, continuous venovenous hemodiafiltration (CVVHDF) was performed with 2-way catheters, usually in the femoral vein. Thrombotic complications in all cases were associated with therapy. In 11 children, thrombosis was localized in the femoral, iliac veins and vena cava inferior. Clinical manifestations in the form of limb edema, cyanosis were noted in 4 patients, in other cases the diagnosis was made by ultrasound. 3 patients with thrombosis of the branches of the central retinal vein, vena cava superior, mesenteric thrombosis. 1 patient was diagnosed with dissecting femoral vein aneurysm. In 3 cases, CVVGDF had to be stopped due to catheter thrombosis. Before the current thrombosis, these children were not prescribed anicoagulants. Coagulation tests indices indicated hypercoagulability and were characterized by higher thrombin time, increased levels of D-dimer, and increased fibrinolysis time. Conclusion Large vessel thrombosis in children with STEC-HUS is a rare complication. The provoking factor for the implementation of thrombotic events in all cases was femoral vein catheterization. When managing patients with STEC-HUS monitoring of coagulation status is needed for the purpose of timely administration of anticoagulants.

Factores que condicionan el desarrollo de trombosis venosa en pacientes con catéter venoso central ingresados en la unidad de cuidados intensivos del hospital de niños Roberto Gilbert Elizalde

Introducción: Los avances en el manejo y supervivencia de la patología pediátrica grave han supuesto un incremento en los fenómenos tromboembólicos, dada la frecuente necesidad de catéteres venosos centrales (CVC). El presente estudio describe las condiciones en las que se presentan trombosis venosas en pacientes pediátricos con uso de CVC en un centro de referencia público de Guayaquil. Métodos: el presente es estudio observacional, de corte transversal, se realizó con el objetivo de identificar factores que condicionaron el desarrollo de trombosis venosa en pacientes con CVC ingresados en la Unidad de Cuidados Intensivos. Se recolectó información en una ficha prediseñada de todos los pacientes con CVC mayor a 7 días y se realizó eco Doppler venoso para identificar la presencia o ausencia de trombos. Se utiliza estadística descriptiva para el análisis univariado y Odds Ratio para el bivariado. Resultados: 35 pacientes ingresaron al estudio, 14/35 (40%) lactantes menores, 24/35 hombres (69%), 19 casos (54%) con malnutrición, 10 casos (29%) con cardiopatía congénita, 18 casos (51%) ingresados por infecciones. El sitio de punción fue femoral en 15 casos (43%), el procedimiento fue realizado por el felow en 20 casos (57%) y en forma programada en 27 casos (77%) y se realizó en un solo intento en 28 casos (80%). La punta del catéter se ubicó en la vena cava superior en 23 casos ( 66%). La prevalencia de trombosis fue del 14% (IC95% 12.33%-16.25). En el análisis bivariado ninguna de las variables fue asociada a la presencia de trombosis de CVC. Conclusiones: El 14% de los pacientes con uso de CVC por más de 7 días desarrollan trombosis venosa secundaria. No de pudieron determinar factores asocia-dos al CVC sobre el estado nutricional y procedimientos relacionados