RESUMO
BACKGROUND: Cervical thoracic duct cysts are a rare anomaly. OBJECTIVE: To report a case of cervical thoracic duct cyst, and perform a literature review. CLINICAL CASE: A 78-year-old female, with a one-year history of a left-sided asymptomatic supraclavicular cystic mass. Computerized tomography revealed a cystic mass 42mm in diameter. We performed a fine needle aspiration puncture, obtaining a thick, milky, whitish liquid. The patient underwent surgery; finding a left-sided supraclavicular cystic mass, with some lymph vessels heading towards the jugulo subclavian venous junction. We performed a ligation of these lymph vessels and resection of the mass. The histopathologic study confirmed the diagnosis of thoracic duct cyst. CONCLUSION: Diagnosis of cervical thoracic duct cyst should be suspected with a cystic lesion in the left supraclavicular region, which when perforated exudes a very distinctive thick milky, whitish liquid with a high content of lymphocytes and triglycerides. Treatment should be complete removal with ligation of the lymphatic afferent vessels.
Assuntos
Cisto Mediastínico/cirurgia , Ducto Torácico/cirurgia , Idoso , Biópsia por Agulha Fina , Feminino , Humanos , Ligadura , Vasos Linfáticos/cirurgia , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/patologia , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/patologia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: This case demonstrates the use of carotid stents in off-label emergency condition where standard self-expandable stents doesn't fit to native artery and balloon-expandable stents could not be also recommended. CASE REPORT: 56 years old patient, EVAR therapy performed 2 months before, suffering acute severe abdominal pain; emergency angioCT showed oclusion of superior mesenteric artery (SMA) and no complications related to previous EVAR. A percutaneuos supraselective trombolysis was performed. After 24 hours control DSA showed partial recanalization and tight stenoses in distal SMA with poor run-off to terminal branches. A 6-8 x 40 mm Carotid Stent (Acculink®, Abbot Vascular) was implanted with good inmediate technical result. After 6 months follow up both SMA and branches remain patent and no further treatment was required. CONCLUSIONS: tapered self expandable uncovered stents are a good treatment option to achieve better conformability to SMA,and bare metal stents do not compromise side-branches of this artery.
