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1.
Angiol Sosud Khir ; 27(1): 91-95, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825734

RESUMO

Demonstrated in the article are the results of catheter-directed thrombolysis in a male patient presenting with bilateral acute iliofemoral venous thrombosis on the background of aplasia of the inferior vena cava. The incidence rate of this pathology is specified, with an emphasis on no recommendations on choosing optimal therapeutic strategy in this cohort of patients. The main causes and complications of the disease are described. The realized policy of revascularization demonstrated its safety and efficacy. The chosen method of correction resulted in a successful outcome of treatment, preventing phlegmasia cerulea dolens. This policy can be recommended as most preferred for patients with acute iliofemoral venous thrombosis on the background of aplasia of the inferior venal cava.


Assuntos
Veia Cava Inferior , Trombose Venosa , Cateteres , Humanos , Veia Ilíaca/diagnóstico por imagem , Masculino , Terapia Trombolítica , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico , Trombose Venosa/tratamento farmacológico
2.
Angiol Sosud Khir ; 27(1): 169-174, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33825745

RESUMO

Hereditary thrombophilia is rare pathology giving rise to a ninefold increase in the risk for the development of thromboembolism in infants. The problem is multifactorial and characterized by high mortality, especially in neonates. Infants who develop thrombosis, particularly those with no family history, are often subjected to testing for hereditary thrombophilia. However, genetic testing for thrombophilia does not change the plan of treatment but makes it possible to perform prevention of thrombosis within the risk periods for the patient. Poor awareness of paediatricians, the complexity of carrying out genetic testing, the absence of approaches supported by evidence-based medicine due to shortage of high-quality clinical trials and no guidelines on prevention of thromboembolism in infants, as well as the frequent occurrence of diversified causes and diseases in different age groups make the problem significant for modern medicine. Further studies are needed to address many unanswered as yet questions.


Assuntos
Tromboembolia , Trombofilia , Trombose , Átrios do Coração/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Trombofilia/complicações , Trombofilia/diagnóstico , Trombofilia/genética , Veia Cava Inferior/diagnóstico por imagem
3.
Rozhl Chir ; 100(2): 88-93, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33910342

RESUMO

INTRODUCTION: Renal cancer is unique for many reasons. One reason is that renal cell carcinoma can grow directly into the drainage veins of the kidney, which enter the inferior vena cava leading to the heart. This growth of tumor cells into the veins is called a tumor thrombus and is a locally aggressive renal cancer. The present article informs about the experience of our cardiac surgery department together with the transplant surgery department in successful surgical removal of a kidney with tumor, with invasion into the inferior vena cava, right atrium of the heart and pulmonary artery in two case reports. CASE REPORTS: A 32 years old female without significant history, with suddenly evolving dyspnea was urgently admitted to hospital. Her condition was suspected to be caused by pulmonary artery embolisation. The diagnosis was confirmed by CT scan which revealed unknown tumor mass of the right kidney and tumor embolisation in inferior vena cava and pulmonary artery. The patient was urgently operated by a vascular surgeon and cardiothoracic surgeon. They successfully performed left radical nephrectomy and total thromboembolectomy of the tumorous masses from vena cava inferior and pulmonary artery. The postoperative course was without complications, postoperative CT revealed no residual masses, and the patient was discharged in a good condition from the hospital. A 58 years old male with arterial hypertension suffered from orchiepididymitis. CT scan showed a tumor of the left kidney with propagation of tumorous masses to inferior vena cava and pulmonary artery. In elective surgery the vascular surgeon and cardiothoracic surgeon successfully performed left radical nephrectomy with total thromboembolectomy of the tumorous masses from inferior vena cava and pulmonary artery. After surgery a temporary paralytic ileus and an episode of atrial fibrillation occurred. Both are common postoperative complications related to the given surgical procedure. Follow-up CT scan showed no residual tumor or thrombus in inferior vena cava and pulmonary artery. Echocardiography revealed persistent dilation of right compartments of the heart with good systolic functions of both ventricles. The patient was discharged from hospital in a good condition. CONCLUSION: Surgical removal of renal tumor and tumor thrombus - radical nephrectomy with tumor thrombectomy - can be a curative treatment and can ensure long-term survival of the patient. Depending on the extent of the tumor thrombus, these operations can be performed in different ways - mini-invasive, robotic or open. When open surgery is used, it is possible to perform the procedure with or without extracorporeal circulation (cardiopulmonary bypass - CPB) depending on the extent of the disease.


Assuntos
Carcinoma de Células Renais , Neoplasias Renais , Embolia Pulmonar , Adulto , Carcinoma de Células Renais/cirurgia , Feminino , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Trombectomia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
4.
Medicine (Baltimore) ; 100(8): e24892, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663119

RESUMO

RATIONALE: Carbon dioxide pneumoperitoneum in laparoscopic surgery can bring about occult perioperative cerebral infarction, advancing our understanding of the causes of severe postoperative delayed recovery. PATIENT CONCERNS: Here, we report the case of a 35-year-old woman who underwent a right renal tumor resection in our institution, during which a raised pneumoperitoneum pressure (from 15 to 20 mm Hg) was adopted by the surgeon to prevent errhysis and to help stop the bleeding. Despite an accidental minor tearing of the inferior vena cava, vital signs remained stable throughout the procedure, and no obvious abnormality was observed in either end tidal carbon dioxide values or blood gas analysis. However, the patient unexpectedly suffered delayed recovery after the operation, presenting incomplete left hemiplegia and a positive Babinski sign. DIAGNOSES: Perioperative stroke was diagnosed by anesthesiologists, after excluding the effects of anesthesia. Cerebral hemorrhage was excluded, as no obvious abnormality was found in the density of brain parenchyma in the emergency computed tomography examination, and a digital subtraction angiography showed no abnormal thrombosis. Further magnetic resonance diagnosis led us to consider diffuse gas embolisms to be the cause of this acute stroke; a right echocardiography revealed that a patent foramen ovale (PFO) may account for the global cerebral gas embolisms. INTERVENTIONS: The patient received neuroprotective drugs (Vinpocetine, Edaravone, and Xingnaojing, which are commonly used as a standard of care in China), antiplatelets and other symptomatic treatments, plus dexamethasone to relieve edema. A contrast-enhanced echocardiography of the right heart was performed, the results of which were consistent with the sonography of a PFO. OUTCOMES: The patient was hospitalized for 14 days and eventually discharged after recovery. At the latest follow-up in August 2019, the patient recovered without residual neurological sequelae. LESSONS: Our results emphasize the need for vigilance regarding adverse cardiovascular and neurological events caused by carbon dioxide gas embolisms when encountering the inadvertent situation of vessels rupturing. Timely monitoring of paradoxical gas embolism by transoesophageal echocardiography is necessary and can avert the risk of severe complications. Urgent consideration should be given to stopping pneumoperitoneum and switching to laparotomy for hemostasis so that the patient can obtain the best benefit-risk ratio.


Assuntos
Dióxido de Carbono/análise , Infarto Cerebral/etiologia , Embolia Paradoxal/complicações , Nefrectomia/efeitos adversos , Veia Cava Inferior/lesões , Adulto , Infarto Cerebral/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Humanos , Insuflação/efeitos adversos , Complicações Intraoperatórias , Imagem por Ressonância Magnética , Período Perioperatório , Veia Cava Inferior/diagnóstico por imagem
7.
Clin Nucl Med ; 46(3): 264-265, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33351509

RESUMO

ABSTRACT: A 61-year-old woman was diagnosed with progressive metastatic radioactive iodine refractory differentiated thyroid cancer and underwent multitargeted tyrosine kinase inhibitor (TKI) Donafenib therapy. After 12 months of therapy, she developed resistance to TKI. Considering the limited treatment options available, a 68Ga-prostate-specific membrane antigen (PSMA)-617 PET/CT was conducted for potential therapeutic target. 68Ga-PSMA-617 PET/CT showed an intense radiotracer uptake in inferior vena cava, which was subsequently confirmed as tumor thrombus. Thus, this patient is a rare case in which the tumor thrombus from thyroid cancer was discovered in inferior vena cava via 68Ga-PSMA-617 PET/CT.


Assuntos
Ácido Edético/análogos & derivados , Oligopeptídeos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Trombose/complicações , Trombose/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Glândula Tireoide/complicações , Veia Cava Inferior/patologia , Veia Cava Inferior/fisiopatologia
8.
Clin Imaging ; 69: 120-125, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32717539

RESUMO

PURPOSE: The aim of this study was to investigate the effect of the cardiac cycle on the vena cava and determine the phase of measuring maximum diameters. METHODS: A total of 152 patients who underwent cardiac computed tomography (CT) were included. Patients' basic information was collected. The major axis, minor axis, and cross-sectional area (CSA) of the vena cava in 10 phases reconstructed at 10% step from 5% to 95% R-R interval were measured in four planes (SVC1 layer: the bifurcation of the pulmonary artery; SVC2 layer: the superior vena cava (SVC) into the right atrium; IVC1 layer: the intersection of the inferior vena cava (IVC) and the right atrium; IVC2 layer: the IVC into the anterior hepatic plane). The difference in vena cava diameters between cardiac cycles was determined using the linear mixed model. RESULTS: The variations in diameter and CSA of the SVC in cardiac cycles were statistically significant (p < 0.05), while those of the suprahepatic IVC were not. In the SVC1 layer, the maximum value of the SVC major and minor axes was observed in 85% and 45% phases, respectively, while that in the SVC2 layer was observed in 45% phases. The maximum SVC diameters in the SVC1 and SVC2 layers were 19.48 ± 2.57 mm and 17.43 ± 3.09 mm, respectively. The SVC and IVC diameters and CSA were positively correlated with the body surface area in the linear mixed model. CONCLUSION: The maximum SVC diameter and CSA were mostly observed in 45% phase, which provides a reference for selecting the best phase to measure the abnormality of vena cava diameter in the future.


Assuntos
Cardiopatias , Veia Cava Superior , Adulto , Átrios do Coração , Humanos , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Superior/diagnóstico por imagem
9.
Vasc Endovascular Surg ; 55(1): 69-72, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32862786

RESUMO

Venous stent placement of symptomatic occlusion of the superior and inferior vena cava is considered the treatment of choice in malignant disease because this technique can restore patency and achieve a relief of symptoms. However, tumor thrombus extension into the right atrium harbors the potential risk of stent migration and perforation. One strategy to avoid this potential life-threatening complication could be the placement of a bridging stent from the superior vena cava-to-inferior vena cava. This case reports describes the superior vena cava-to-inferior vena cava bridging stent technique in 2 patients with malignant occlusion of the superior and inferior vena cava. Special considerations such as technical details of the devices and potential complications are discussed.


Assuntos
Procedimentos Endovasculares/instrumentação , Átrios do Coração , Neoplasias/complicações , Stents , Síndrome da Veia Cava Superior/terapia , Veia Cava Inferior , Veia Cava Superior , Trombose Venosa/terapia , Idoso , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/patologia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/patologia
10.
Angiol Sosud Khir ; 26(4): 63-69, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332307

RESUMO

Described in the article is a clinical case report regarding successful surgical treatment of a female patient with total floating thrombosis of the inferior vena cava and thrombosis of the right atrium, complicated by pulmonary embolism. Our patient was a 42-year-old woman presenting with a clinical pattern of iliofemoral thrombosis. The examination revealed floating thrombosis of the inferior venal cava, right atrial thrombosis, and massive pulmonary embolism. Given the presence of absolute contraindications to systemic thrombolysis, it was decided to carry out surgical treatment by means of a hybrid-operation procedure. The woman underwent successful direct thrombectomy from the right-atrium cavity and branches of the pulmonary artery in conditions of artificial blood circulation, simultaneously accompanied by removing the floating thrombus from the inferior vena cava with the help of the 'Track' system, as well as by placement of a cava filter. Also presented herein is a review of the world experience gained in treating this pathology, followed by substantiation of using a hybrid approach for achieving an optimal clinical outcome.


Assuntos
Embolia Pulmonar , Trombose , Filtros de Veia Cava , Adulto , Feminino , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Trombectomia , Trombose/diagnóstico , Trombose/etiologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
11.
Angiol Sosud Khir ; 26(4): 149-154, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332317

RESUMO

Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.


Assuntos
Laparoscopia , Embolia Pulmonar , Filtros de Veia Cava , Remoção de Dispositivo , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
12.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334755

RESUMO

Renal biopsy is usually a prerequisite in the diagnosis of adult patients with nephrotic syndrome. Acute Budd Chiari syndrome is a known complication of certain aetiologies of nephrotic syndrome like membranous glomerulopathy and minimal change disease. This complication requires emergent anticoagulation, which would preclude the performance of a renal biopsy. We report the case of a 47-year-old woman who presented with acute Budd Chiari syndrome as the initial presentation of nephrotic syndrome. The difficult situation in which we had to give anticoagulation and also perform a renal biopsy led us to devise a novel way to treat the patient, namely, the initial use of transfemoral thrombolysis and thrombosuction followed by a renal biopsy, which confirmed the diagnosis of primary membranous nephropathy. Anticoagulation was safely instituted 48 hours later with documented clinical and radiological improvement.


Assuntos
Síndrome de Budd-Chiari/terapia , Glomerulonefrite Membranosa/diagnóstico , Síndrome Nefrótica/diagnóstico , Terapia Trombolítica/métodos , Angiografia , Anticoagulantes/administração & dosagem , Biópsia/métodos , Síndrome de Budd-Chiari/etiologia , Feminino , Fibrinólise , Membrana Basal Glomerular/patologia , Glomerulonefrite Membranosa/complicações , Glomerulonefrite Membranosa/patologia , Humanos , Pessoa de Meia-Idade , Síndrome Nefrótica/etiologia , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem
14.
Zhonghua Yi Xue Za Zhi ; 100(43): 3425-3430, 2020 Nov 24.
Artigo em Chinês | MEDLINE | ID: mdl-33238673

RESUMO

Objective: To evaluate the influence of preoperative fasting duration on blood volume status of pediatric patients during induction based on ultrasonic technique. Methods: One hundred and ten pediatric patients, scheduled for elective operation in the Second Affiliated Hospital & Yuying Children's Hospital, were recruited during January and October in 2018. After sedation by inhalation of sevoflurane, the maximum (expiratory) and minimum (inspiratory) diameter of inferior vena cava (IVC(max), IVC(min)) and aorta velocity-time integral (VTI) in apical five-chamber cardiac view were measured with an ultrasound machine. Respiratory variabilities of these parameters were further calculated. Furthermore, passive leg raising (PLR) test was performed and above measurements/calculations were repeated. The correlation between the duration of fasting and IVC respiratory variations index (IVC(RVI)) or aortic VTI variability (ΔVTI) was then analyzed. Results: Before PLR, IVC(max), IVC(min) and IVC(RVI) were (0.78±0.19), (0.43±0.15) cm and 0.45±0.12, respectively. After PLR, IVC(max) and IVC(min) increased to (0.94±0.20), (0.55±0.18) cm, while IVC(RVI) decreased to 0.42±0.13, the differences were statistically significant (t=15.66, 10.85, 3.14, all P<0.05). However, IVC(max), IVC(min) and IVC(RVI) were not significantly correlated with the duration of fasting analyzed by linear regression (before PLR: r=0.052, 0.163, 0.171; after PLR, r=0.062, 0.169, 0.165, all P>0.05). Before PLR, expiratory aortic VTI (VTI(max)), inspiratory aortic VTI (VTI(min)) and ΔVTI were 21±5, 17±4 and 17±8, respectively. After PLR, the VTI(max) and VTI(min) significantly increased to 23±5 and 19±4 (t=13.60, 10.43, all P<0.05), but ΔVTI was not changed significantly, which was 17±8(t=0.34, P>0.05). Linear regression analysis showed that VTI(max), VTI(min) and ΔVTI were not significantly correlated with the duration of fasting (before PLR: r=0.111, 0.100, 0.047; after PLR: r=0.003, 0.033, 0.073, all P>0.05). Further multiple linear regression analysis indicated that, age and body weight were independent factors influencing IVC(RVI) and ΔVTI before and after PLR (IVC(RVI): ß=-0.441, 0.515, -0.451, 0.507; ΔVTI: ß=-0.442, 0.545, -2.422, 2.850; all P<0.05). However, the duration of fasting was not correlated with IVC(RVI) and ΔVTI after adjusting the age and weight (IVC(RVI): ß=0.177, 0.160; ΔVTI: ß=0.037, 0.054; all P>0.05). Conclusion: Age and weight, but not preoperative fasting duration, are correlated with respiratory variabilities of inferior vena cava diameter and aortic VTI in pediatric patients.


Assuntos
Jejum , Ultrassom , Volume Sanguíneo , Criança , Humanos , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem
15.
J Assoc Physicians India ; 68(11): 74-76, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33187045

RESUMO

Leiyomyosarcoma of vascular origin is rarely seen occurring in the Inferior Vena Cava. We report a rare case of a young male with giant retroperitoneal leiyomyosarcoma which extended into the right atrium.


Assuntos
Fibrilação Atrial , Leiomiossarcoma , Neoplasias Vasculares , Átrios do Coração/diagnóstico por imagem , Humanos , Leiomiossarcoma/diagnóstico por imagem , Masculino , Veia Cava Inferior/diagnóstico por imagem
16.
J Small Anim Pract ; 61(11): 659-668, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33035379

RESUMO

OBJECTIVE: To re-evaluate the anatomy and classification of congenital extrahepatic portosystemic shunts entering the caudal vena cava at the level of the omental foramen. MATERIAL AND METHODS: A retrospective review of a consecutive series of dogs undergoing CT angiography as part of the diagnostic work-up for a congenital extrahepatic portosystemic shunt. RESULTS: In total, 53 dogs met the inclusion criteria revealing four anatomically distinct omental foramen shunt types; one of which (32 of 53 dogs) showed no shunting blood flow through the right gastric vein and three of which (21 of 53 dogs) involved shunting flow through this vessel. The anatomy of these four distinct shunt types, as defined by CT angiography, was found to be highly consistent. In all cases, regardless of the tributary vessels, the left gastric vein was the final vessel that communicated with the caudal vena cava. Using these findings, a more accurate naming classification for congenital portosystemic shunts entering the caudal vena cava at the level of the omental foramen was proposed. CLINICAL SIGNIFICANCE: A precise pre-treatment anatomical classification of congenital extrahepatic portosystemic shunts entering the caudal vena cava at the level of the omental foramen is important for a more complete understanding of the severity of clinical signs and prognosis, and for the better communication between clinicians and researchers in this clinical field.


Assuntos
Doenças do Cão , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Sistema Porta/diagnóstico por imagem , Veia Porta , Derivação Portossistêmica Cirúrgica/veterinária , Estudos Retrospectivos , Veia Cava Inferior/diagnóstico por imagem
17.
Medicine (Baltimore) ; 99(43): e22880, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120831

RESUMO

The collapsibility and diameter of the inferior vena cava (IVC) are known to predict the volume state in critically ill patients. However, no study has examined the prognostic value of the IVC diameter ratio measured on computed tomography (CT) in patients with septic shock. A retrospective observational study was conducted on adult septic shock patients visiting the emergency department at a university hospital in Korea. The IVC diameter ratio was calculated by dividing the maximal transverse and anteroposterior diameters. Multivariable logistic regression analysis was conducted to investigate whether the IVC diameter ratio predicted in-hospital mortality. The area under the curve (AUC) was calculated, and the sensitivity, specificity, positive predictive value, and negative predictive value with the cut-off values were computed. A total of 423 adult septic shock patients were included, and the in-hospital mortality rate was 17%. The median IVC diameter ratio in non-survivors was significantly greater than in survivors (1.56 cm vs 1.4 cm, P = .004). The IVC diameter ratio was found to be significantly associated with in-hospital mortality on multivariate logistic regression analysis after adjustment for confounding variables (odds ratio = 1.48, confidence interval: 1.097-1.998, P = 0.01). The AUC for IVC diameter ratio was 0.607. A cut-off IVC diameter ratio of ≥1.31 cm had 75% sensitivity and 42% specificity for predicting in-hospital mortality. The IVC diameter ratio measured on CT may to be helpful in predicting the prognosis of septic shock patients. However, due to its low diagnostic performance and sensitivity, further research is warranted.


Assuntos
Choque Séptico/mortalidade , Tomografia Computadorizada por Raios X/métodos , Veia Cava Inferior/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estado Terminal/mortalidade , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Choque Séptico/epidemiologia , Veia Cava Inferior/anatomia & histologia
19.
Clin Nucl Med ; 45(11): 900-901, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32910051

RESUMO

A 69-year-old man with a history of back pain, urinary obstruction, and deep vein thrombosis of both lower extremities 4 years earlier was diagnosed with rectal neuroendocrine tumor, grade 2, Ki-67 index 3%. Ga-DOTANOC PET/CT images showed a left pelvic mass extended to the lumen of the inferior vena cava with a high affinity for somatostatin receptor. A tubular focus of radiotracer accumulation after the course of inferior vena cava with filling defect was suggestive of tumor thrombus.


Assuntos
Tumores Neuroendócrinos/complicações , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retais/complicações , Trombose/complicações , Trombose/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Idoso , Humanos , Masculino , Veia Cava Inferior/patologia
20.
Anticancer Res ; 40(10): 5837-5844, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988913

RESUMO

BACKGROUND/AIM: Renal cell carcinoma (RCC) is one of the most common malignancies of the urinary tract. Venous migration, tumor thrombus and metastases are often seen in patients with RCC and are adverse prognostic factors. Intravascular tumor growth along the renal vein into the inferior vena cava occurs in up to 10% of all patients with RCC. Furthermore, extension of the tumor reaching the right atrium is detected in approximately 1% of all patients. Synchronous involvement of pulmonary arteries with tumor emboli is very rare and challenging. Management of metastatic RCC includes surgical resection of renal and metastatic lesions. We present 3 cases of patients with RCC tumor thrombus extending into the inferior vena cava (IVC) and with pulmonary emboli of the tumor thrombus into one of the branches of the main pulmonary artery. All the cases had simultaneous resection of the kidney tumor with the tumor thrombus and pulmonary lobectomy that included the tumor emboli with satisfactory outcome. CASE REPORT: We present a series of cases of RCC with tumor extension into the inferior vena cava (IVC) and with tumor emboli to the pulmonary arteries. Surgical procedure in all cases consisted of radical nephrectomy with IVC tumor thrombus resection, along with a thoracotomy with lung resection including the tumor emboli to one of the branches of the main pulmonary artery. Synchronous metastatic lesions were found on the liver in one case and contiguous extension of renal tumor to the pancreas in another. CONCLUSION: In patients with IVC thrombus with synchronous pulmonary artery tumor embolus, such as the cases presented in this series, a careful multidisciplinary management approach is preferable. Transplant technique used in our open approach minimizes complications, blood loss, and provides excellent visualization for abdominal vascular manipulation of IVC. This provides a potentially curable treatment option with acceptable survival rates.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Pulmonares/cirurgia , Artéria Pulmonar/cirurgia , Veia Cava Inferior/cirurgia , Adulto , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Feminino , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Rim/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/secundário , Metástase Neoplásica , Células Neoplásicas Circulantes/metabolismo , Células Neoplásicas Circulantes/patologia , Nefrectomia/métodos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Veias Renais/diagnóstico por imagem , Veias Renais/patologia , Veias Renais/cirurgia , Trombose/diagnóstico por imagem , Trombose/patologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia , Trombose Venosa/cirurgia
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