RESUMEN
BACKGROUND: The purpose of this study was to investigate the effect of our revamped MIE-McKeown operation on postoperative gastrointestinal function recovery. METHODS: This revamped MIE-McKeown operation without removing azygos vein arch, bronchial artery and vagus nerve trunk and with the tubular stomach buried throughout esophageal bed and azygos arch, has been implemented from July 2020 to July 2021 by the same medical team of Gaozhou People's Hospital thoracic surgery for 13 times. Preoperative clinical data, main intraoperative indicators and postoperative complications were observed. RESULTS: All patients had esophageal malignant tumors at the level of middle and lower thoracic non-azygous venous arch, with preoperative clinical stage CT1-2N0M0 stage i-ii. V-vst test was performed on the 7th postoperative day, and 10 patients were found to have no loss of safety/efficacy. There were 2 cases with impaired efficacy and no impaired safety, 1 case with impaired safety. There were 1 cases of pulmonary infection, 1 cases of anastomotic fistula combined with pleural and gastric fistula, 2 cases of hoarseness, 2 cases of arrhythmia, 10 cases of swallowing function were grade i, 2 cases of swallowing function were grade iii, 1 case of swallowing function was grade iv in watian drinking water test one month after operation. CONCLUSIONS: Merit of this revamped MIE-McKeown operation is well preserving the integrity of azygos arch of vagus nerve and bronchial artery, and it is technically safe and feasible. No postoperative mechanical obstruction of thoracostomach, huge thoracostomach and gastrointestinal dysfunction occurs.
Asunto(s)
Vena Ácigos , Neoplasias Esofágicas , Humanos , Vena Ácigos/cirugía , Vena Ácigos/patología , Arterias Bronquiales/patología , Esofagectomía/efectos adversos , Estudios Retrospectivos , Esófago , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Complicaciones Posoperatorias/etiologíaRESUMEN
The superior vena cava is formed during the fetal period by the development of anastomoses between the right and left anterior cardinal veins, and the regression of the central part of the left anterior cardinal vein. The persistence of this part of the left anterior cardinal vein causes the formation of a left superior vena cava, which is a rare anomaly in cadaver dissection. We report the case of a persistent left superior vena cava with a normal right superior vena cava in a 95-year-old male cadaver, which was discovered during anatomical dissection for medical students at Kawasaki Medical School in 2016. The left superior vena cava was formed by the confluence of the left internal jugular and left subclavian veins and terminated in the right atrium via what would normally be the coronary sinus. The right and left superior venae cavae received intercostal veins via a right and left azygos vein, respectively. However, the right azygos vein was shorter than the normal azygos vein and received only the second to fifth intercostal veins, whereas the left azygos vein received the fifth to eleventh left intercostal veins and the sixth to eleventh right intercostal veins. We consider that the anomalies of the azygos venous system were the result of regression of right supracardinal vein and the persistence of the left supracardinal vein during development. An awareness of such variations of major thoracic veins is important for the interpretation of unusual CT images.
Asunto(s)
Anomalías Múltiples , Vena Ácigos/anomalías , Seno Coronario/anomalías , Vena Cava Superior/anomalías , Anciano de 80 o más Años , Vena Ácigos/patología , Seno Coronario/patología , Humanos , Masculino , Vena Cava Superior/patologíaAsunto(s)
Vena Ácigos/diagnóstico por imagen , Atrios Cardíacos/diagnóstico por imagen , Neoplasias/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Vena Cava Superior/diagnóstico por imagen , Anciano , Vena Ácigos/patología , Vena Ácigos/efectos de la radiación , Fraccionamiento de la Dosis de Radiación , Atrios Cardíacos/patología , Humanos , Masculino , Neoplasias/patología , Neoplasias/radioterapia , Valor Predictivo de las Pruebas , Radioterapia Conformacional , Vena Cava Superior/patología , Vena Cava Superior/efectos de la radiaciónRESUMEN
A 2-year-old Airedale terrier was presented with exercise intolerance since birth and newly developed chylous pleural effusion. Imaging procedures including echocardiography, cardiac magnetic resonance imaging, computed tomography, and selective angiography revealed an aberrant connection of the azygos vein and the left atrium, a membrane in the right atrium consistent with cor triatriatum dexter, and a patent foramen ovale with right-to-left shunt. Balloon dilation of the membrane in the right atrium seemed to result in transient improvement of exercise tolerance compared with the previous 2 years. When chylothorax relapsed after three months, the dog was euthanized. Necropsy confirmed the azygos vein to left atrial connection, the patent foramen ovale, and the cor triatriatum dexter.
Asunto(s)
Vena Ácigos/patología , Enfermedades de los Perros/patología , Foramen Oval Permeable/veterinaria , Animales , Enfermedades de los Perros/diagnóstico por imagen , Enfermedades de los Perros/etiología , Perros , Femenino , Foramen Oval Permeable/complicaciones , Foramen Oval Permeable/diagnóstico por imagen , Foramen Oval Permeable/patologíaRESUMEN
The azygos system is the most important pathway for decompression of the superior vena cava (SVC) when a blood flow obstruction to the right atrium is present. Thoracic and mediastinal malignancies, mainly lung cancers, are responsible for 60%-85% of superior vena cava syndrome (SVCS) cases. An uncommon origin of SVCS is primary malignant mediastinal germ cell tumor (PMMGCT) which represent 1%-4% of all mediastinal tumors and can be divided into two broad groups: seminomas and nonseminomatous germ cell tumors (NSGCTs). Primary mediastinal seminomas clinical presentation is often nonspecific, even if the majority of patients present with superior vena cava involvement. Here, we present the radiologic features of asymptomatic azygos system overflow in a patient with primary mediastinal seminoma.
Asunto(s)
Vena Ácigos/patología , Neoplasias del Mediastino/diagnóstico , Seminoma/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biomarcadores , Humanos , Inmunohistoquímica , Masculino , Neoplasias del Mediastino/tratamiento farmacológico , Mediastino/patología , Seminoma/tratamiento farmacológico , Síndrome de la Vena Cava Superior , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenAsunto(s)
Aneurisma/diagnóstico por imagen , Vena Ácigos/diagnóstico por imagen , Tos/etiología , Enfermedades del Mediastino/diagnóstico por imagen , Mediastino/diagnóstico por imagen , Ultrasonografía , Anciano , Aneurisma/patología , Vena Ácigos/patología , Enfermedad Crónica , Tos/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Enfermedades del Mediastino/patología , Mediastino/patologíaAsunto(s)
Vena Ácigos/patología , Síndrome Postrombótico/patología , Síndrome de la Vena Cava Superior/patología , Trombosis/patología , Anciano , Angiografía por Tomografía Computarizada , Humanos , Masculino , Síndrome Postrombótico/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Vena Cava Superior/patologíaRESUMEN
This report describes a case of isthmus-dependent atrial ï¬utter ablation by the femoral approach in a 54-year-old woman with a previously unknown absence of the inferior vena cava (IVC) and dual chamber pacemaker. Despite looping of the catheters, ablation and termination of atrial ï¬utter were performed successfully without function alteration of the pacemaker leads. This is the ï¬rst report of an inferior-to-superior approach for ablation of atrial ï¬utter in the absence of the perihepatic IVC with the presence of chronic indwelling leads in the area targeted for radiofrequency.
Asunto(s)
Aleteo Atrial/cirugía , Vena Ácigos , Ablación por Catéter/métodos , Cardiopatías Congénitas/cirugía , Marcapaso Artificial , Vena Cava Inferior , Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/patología , Malformaciones Arteriovenosas/cirugía , Aleteo Atrial/etiología , Aleteo Atrial/patología , Vena Ácigos/anomalías , Vena Ácigos/patología , Vena Ácigos/cirugía , Femenino , Vena Femoral/patología , Vena Femoral/cirugía , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/patología , Humanos , Persona de Mediana Edad , Válvula Tricúspide/cirugía , Vena Cava Inferior/anomalías , Vena Cava Inferior/patología , Vena Cava Inferior/cirugíaAsunto(s)
Vena Ácigos , Neoplasias de los Conductos Biliares , Colangiocarcinoma , Trombosis , Tomografía Computarizada por Rayos X/métodos , Vena Ácigos/diagnóstico por imagen , Vena Ácigos/patología , Neoplasias de los Conductos Biliares/complicaciones , Neoplasias de los Conductos Biliares/patología , Colangiocarcinoma/complicaciones , Colangiocarcinoma/patología , Medios de Contraste/farmacología , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Intensificación de Imagen Radiográfica/métodos , Trombosis/diagnóstico , Trombosis/etiología , Trombosis/fisiopatologíaAsunto(s)
Aneurisma/diagnóstico , Vena Ácigos/patología , Metástasis Linfática/diagnóstico , Anciano , Aneurisma/patología , Aneurisma Roto/diagnóstico , Aneurisma Roto/etiología , Vena Ácigos/lesiones , Biopsia/efectos adversos , Carcinoma de Células Escamosas/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Hallazgos Incidentales , Periodo Intraoperatorio , Neoplasias Pulmonares/cirugía , Nódulo Pulmonar Solitario/cirugía , Cirugía Torácica Asistida por VideoAsunto(s)
Vena Ácigos/diagnóstico por imagen , Dolor en el Pecho/diagnóstico por imagen , Colangiopancreatografia Retrógrada Endoscópica , Coledocolitiasis/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Trombosis de la Vena/diagnóstico por imagen , Vena Ácigos/patología , Dolor en el Pecho/etiología , Coledocolitiasis/cirugía , Humanos , Complicaciones Intraoperatorias , Masculino , Persona de Mediana Edad , Trombosis de la Vena/patología , Espera VigilanteAsunto(s)
Anomalías Múltiples/diagnóstico por imagen , Venas Hepáticas/anomalías , Malformaciones Vasculares/diagnóstico por imagen , Vena Cava Inferior/anomalías , Anciano , Vena Ácigos/diagnóstico por imagen , Vena Ácigos/patología , Femenino , Venas Hepáticas/diagnóstico por imagen , Humanos , Hipertrofia/diagnóstico por imagen , Hallazgos Incidentales , Tomografía Computarizada por Rayos XRESUMEN
The implanted venous access catheter is commonly used in the treatment of oncology patients. Although common long-term complications of these devices, such as infection and thrombosis, have been widely reported, venous-airway fistula due to port placement is an extremely rare and poorly understood complication. We report a case of a 56-year-old woman with pancreatic adenocarcinoma whose implanted catheter was complicated by the development of an azygo-bronchial fistula with a concomitant aspergilloma. Herein is the first reported case of successful venous-airway fistula closure obtained through silicone stenting.
Asunto(s)
Aspergilosis/complicaciones , Vena Ácigos/patología , Fístula Bronquial/patología , Broncoscopía/instrumentación , Catéteres de Permanencia/efectos adversos , Neoplasias Pancreáticas/complicaciones , Adenocarcinoma/patología , Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico por imagen , Aspergilosis/tratamiento farmacológico , Aspergilosis/patología , Fístula Bronquial/diagnóstico por imagen , Fístula Bronquial/etiología , Fístula Bronquial/microbiología , Broncoscopía/métodos , Catéteres de Permanencia/microbiología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Pancreáticas/patología , Siliconas/uso terapéutico , Stents/estadística & datos numéricos , Tomógrafos Computarizados por Rayos X , Resultado del Tratamiento , Voriconazol/uso terapéuticoRESUMEN
A 52-year-old woman presented with relapsing acute pancreatitis. A contrast CT scan revealed polysplenia, agenesis of the dorsal pancreas, preduodenal portal vein, inferior vena cava with persistent continuity of the azygos vein, abnormal lung lobation with bilateral left bronchial morphology, and intestinal malrotation (non-rotation type). To the best of our knowledge, this is the first report in which successful pancreatic duct stent placement for the treatment of recurrent pancreatitis was performed in a polysplenia patient with agenesis of the dorsal pancreas, separate bile and pancreatic ducts and Peutz-Jeghers syndrome.
Asunto(s)
Anomalías Congénitas , Páncreas/anomalías , Pancreatitis Crónica/complicaciones , Pancreatitis Crónica/cirugía , Síndrome de Peutz-Jeghers/complicaciones , Stents , Vena Ácigos/patología , Anomalías del Sistema Digestivo , Femenino , Humanos , Vólvulo Intestinal , Persona de Mediana Edad , Conductos Pancreáticos/cirugía , Vena Porta/patología , Tomografía Computarizada por Rayos X , Vena Cava Inferior/patologíaAsunto(s)
Aneurisma/patología , Vena Ácigos/patología , Enfermedades Torácicas/patología , Adenocarcinoma/complicaciones , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Anciano , Aneurisma/complicaciones , Aneurisma/diagnóstico por imagen , Vena Ácigos/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Masculino , Radiografía Torácica , Enfermedades Raras , Neoplasias del Recto/complicaciones , Neoplasias del Recto/diagnóstico por imagen , Neoplasias del Recto/patología , Enfermedades Torácicas/complicaciones , Enfermedades Torácicas/diagnóstico por imagenRESUMEN
The azygos system of veins varies greatly in its mode of origin, but the variation in which the azygos vein is a continuation of the inferior vena cava (IVC) is rare. During an oesophagectomy, the azygos vein typically is transected as a requirement of the surgery. In this case, the enlarged azygos and its arch were a continuation of the IVC. During our procedure, we first established a bypass between the right femoral vein and the jugular vein in case of injury to the azygos vein, and we then performed a McKeown oesophagectomy without transecting the azygos vein. Our experience suggests that an oesophagectomy in cases with an azygos vein continuation of the IVC is feasible. An adequate medical examination and careful reading of the imaging is crucial for the safety of these surgical procedures. An appropriate surgical approach should be selected according to the location of the tumour, the size of the tumour and its anatomical features. The establishment of a veno-venous bypass and protection of the azygos arch in patients whose azygos vein is a continuation of IVC is necessary.
Asunto(s)
Vena Ácigos/anomalías , Vena Ácigos/cirugía , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Esofagectomía , Vena Cava Inferior/cirugía , Vena Ácigos/patología , Carcinoma de Células Escamosas/patología , Neoplasias Esofágicas/patología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Vena Cava Inferior/patologíaAsunto(s)
Aneurisma/cirugía , Vena Ácigos/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/métodos , Stents , Anciano , Aneurisma/diagnóstico , Vena Ácigos/patología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Angiografía por Resonancia Magnética/métodos , Neoplasias del Mediastino/diagnóstico , Embolia Pulmonar/diagnóstico , Medición de Riesgo , Resultado del TratamientoRESUMEN
A 59-year-old Indian woman presented to the respiratory clinic with chest pains, long-standing swallowing difficulties and a chest radiograph, which was reported as showing a shadow in the right paratracheal region. A CT scan was obtained and was reported as demonstrating a right-sided paratracheal lymph node and varicosities adjacent to the inferior vena cava. Histology from an endobronchial ultrasound-guided biopsy revealed a heavily blood-stained sample but showed no evidence of granulomas or malignancy. Subsequently, the images were reviewed, with the conclusion that they were actually of an engorged azygos vein compressing the oesophagus. MRI confirmed the absence of mediastinal lymphadenopathy and the presence of a prominent hemiazygos vein compressing the oesophagus. This case highlights the importance of including anatomical abnormalities in the differential diagnosis and reassessing patients when the history and investigations do not correlate.