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1.
Medicine (Baltimore) ; 99(11): e19392, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176064

RESUMO

RATIONALE: Renal carcinoma is a common malignant tumor of the urinary system, 4%-10% of which are complicated with tumor thrombi in the renal vein and the inferior vena cava; in about 1% of patients, the inferior vena cava tumor thrombus invades the right atrium. Surgery is the treatment of choice. Real-time monitoring with transesophageal echocardiography (TEE) has been widely used in various operations, including cardiac and non-cardiac operations for congenital heart diseases, coronary diseases, vascular heart diseases, and aorta diseases, etc. In this article, a case of a patient with right renal carcinoma complicated with an inferior vena cava tumor thrombus is reported. PATIENT CONCERNS: A 52-year-old man who was admitted to our hospital for lumbar pain lasting for one month. DIAGNOSIS: Right renal carcinoma complicated with an inferior vena cava tumor thrombus. INTERVENTIONS: Radical nephrectomy of the renal carcinoma and removal of an inferior vena cava tumor thrombus under real-time monitoring with TEE were performed. OUTCOMES: Radical nephrectomy was successfully performed within 5 minutes after the inferior vena cava was clamped, and then the inferior vena cava tumor thrombus was removed. On the second day after the operation, the patient's conditions improved; his consciousness was clear; he was transferred to a general ward. On the third day after the operation, the patient was able to get out of bed and was discharged on the sixth day after the operation. LESSONS: Real-time monitoring with TEE played an important role in many aspects in the radical nephrectomy of the renal carcinoma and removal of the inferior vena cava tumor thrombus.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Trombectomia/métodos , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Ultrassonografia de Intervenção , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/patologia
2.
Vasc Endovascular Surg ; 54(3): 297-300, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31950885

RESUMO

A 23-year-old presenting with an acute history of back pain, leg swelling, and claudication was diagnosed with an extensive iliocaval thrombosis, extending from the popliteal veins into the inferior vena cava (IVC) and left renal vein. He was treated with a combination of endovascular techniques, including EKOS and AngioJet. An underlying congenital IVC stenosis and May-Thurner type iliac vein compression were subsequently treated with venoplasty and stenting. To our knowledge, this is the first report of the use of EKOS for renal vein thrombosis and we highlight the complementary nature of different endovascular techniques for managing complex venous thrombotic disease.


Assuntos
Procedimentos Endovasculares , Veia Ilíaca , Síndrome de May-Thurner/terapia , Veia Poplítea , Veias Renais , Veia Cava Inferior , Trombose Venosa/terapia , Anticoagulantes/uso terapêutico , Procedimentos Endovasculares/instrumentação , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Síndrome de May-Thurner/diagnóstico por imagem , Síndrome de May-Thurner/fisiopatologia , Veia Poplítea/diagnóstico por imagem , Veia Poplítea/fisiopatologia , Veias Renais/diagnóstico por imagem , Veias Renais/fisiopatologia , Stents , Resultado do Tratamento , Grau de Desobstrução Vascular , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Adulto Jovem
4.
Clin Nucl Med ; 45(2): e103-e105, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876802

RESUMO

Primary Ewing sarcoma/primitive neuroectodermal tumor is a group of rare aggressive tumors in adults derived from neuroectoderm, and primary renal involvement is extremely rare. We describe an F-FDG PET/CT findings of a 28-year-old man who presented with left renal mass with inferior vena cava thrombus, which turned out to be primary Ewing sarcoma on histopathology specimen post left nephrectomy.


Assuntos
Neoplasias Renais/diagnóstico por imagem , Tumores Neuroectodérmicos/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoma de Ewing/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Adulto , Fluordesoxiglucose F18 , Humanos , Neoplasias Renais/complicações , Masculino , Tumores Neuroectodérmicos/complicações , Compostos Radiofarmacêuticos , Sarcoma de Ewing/complicações , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/complicações
5.
Clin Nucl Med ; 45(2): e112-e114, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876813

RESUMO

Secondary involvement of inferior vena cava is a common presentation in aggressive solid malignancies, especially arising from kidneys, adrenals, and hepatobiliary system, mostly resulting from local infiltration. Rarely, primary tumors are seen arising from vascular tissue. The Ewing family of tumors commonly arises from bone, but there is a high propensity of these tumors to originate from nonosseous sites of mesenchymal cell origin. We would herewith demonstrate a rare presentation of Ewing sarcoma, seen originating from inferior vena cava, presenting as extensive intravascular tumor thrombosis, evaluated on FDG PET/CT imaging in a 12-year-old girl.


Assuntos
Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Sarcoma de Ewing/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Criança , Feminino , Fluordesoxiglucose F18 , Humanos , Compostos Radiofarmacêuticos , Veia Cava Inferior/patologia
6.
Int Braz J Urol ; 46(1): 92-100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31851465

RESUMO

PURPOSE: To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two offline readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed. RESULTS: Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was na indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value. CONCLUSION: Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.


Assuntos
Carcinoma de Células Renais/diagnóstico por imagem , Neoplasias Renais/diagnóstico por imagem , Ultrassonografia Doppler/métodos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Idoso , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Meios de Contraste , Feminino , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Reprodutibilidade dos Testes , Estudos Retrospectivos , Trombectomia/métodos , Carga Tumoral , Veia Cava Inferior/patologia , Veia Cava Inferior/cirurgia , Trombose Venosa/patologia , Trombose Venosa/cirurgia
7.
J Clin Ultrasound ; 48(1): 56-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31364173

RESUMO

Sinus venosus atrial septal defect (ASD) accounts for 5% to 10% of ASDs. In contrast with the more common superior vena cava (SVC) type, the inferior vena cava (IVC) type of sinus venosus ASD with overriding IVC is extremely rare. The sinus venosus defect occur posterior to the fossa ovalis and is not regarded as true ASD. Transesophageal echocardiography (TEE) is a diagnostic procedure of choice due to close proximity of atrial septum to TEE transducer. However; it may not constantly yield detailed anatomical and functional characterization, and other imaging modalities such as cardiac magnetic resonance imaging (MRI) may be needed. We report the case of a 45-year-old woman with an undiagnosed hemodynamically significant IVC-type ASD without any anomalous drainage of pulmonary veins, who presented with progressive dyspnea.


Assuntos
Ecocardiografia Transesofagiana , Comunicação Interatrial/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Diagnóstico Tardio , Feminino , Humanos , Pessoa de Meia-Idade , Veia Cava Inferior/anormalidades
8.
Cancer Imaging ; 19(1): 79, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791422

RESUMO

BACKGROUND: Vena cava thrombus is one of the main clinical manifestations of locally aggressive renal cell carcinoma (RCC). Inferior vena cava (IVC) wall invasion and presence of bland thrombus could affect the surgical outcome. This study aims to assess the value of contrast-enhanced ultrasound (CEUS) in detecting wall invasion and differentiating bland thrombus from tumor thrombus during robot-assisted IVC thrombectomy for RCC. METHODS: The intraoperative CEUS findings of 60 patients with RCC accompanied by IVC tumor thrombus were retrospectively analyzed. The CEUS features were compared with the intra- and post-operative pathological findings. CEUS in patients with wall invasion showed that the tumor thrombus was enhanced synchronously with the IVC wall, and the continuity of the IVC wall was lost. In contrast, in patients without wall invasion, CEUS showed that the contrast agent could pass between the tumor thrombus and the IVC wall, and the continuity of IVC wall was good. Typically, contrast-enhanced perfusion was seen in tumor thrombus but not in bland thrombus. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CEUS were statistically analyzed. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the typical enhancement mode of CEUS were 93.1, 93.5, 93.3, 93.1, and 93.5% in identifying wall invasion and 100, 96, 96.7, 83.3, and 100% in differentiating bland thrombus from tumor thrombus, respectively. There were excellent inter-observer agreements for identifying IVC wall invasion and differentiating bland thrombus from tumor thrombus with kappa coefficients of 0.90 and 0.97. CONCLUSIONS: The present study indicates that intraoperative CEUS plays an important role in robot-assisted IVC thrombectomy for RCC. It can detect wall invasion and differentiate bland thrombus from tumor thrombus, thus offering real-time information to the operator during surgery.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Células Neoplásicas Circulantes , Trombectomia/métodos , Trombose/diagnóstico por imagem , Ultrassonografia/métodos , Veia Cava Inferior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Meios de Contraste , Feminino , Humanos , Cuidados Intraoperatórios , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/diagnóstico por imagem , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Trombose Venosa/patologia
9.
Anticancer Res ; 39(12): 6603-6620, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810926

RESUMO

BACKGROUND: In clinical medicine, little is known about the use of allografts for portal vein (PV) reconstruction after pancreaticoduodenectomy (PD). Portal and caval systems are physiologically different, therefore the properties of allografts from caval and portal systems were studied here in a pig model. MATERIALS AND METHODS: PD with PV reconstruction with allogeneic venous graft from PV or inferior vena cava (IVC) was performed in 26 pigs. Biochemical analysis and ultrasonography measurements were performed during a 4-week monitoring period. Computer simulations were used to evaluate haemodynamics in reconstructed PV and explanted allografts were histologically examined. RESULTS: The native PV and IVC grafts varied in histological structure but were able to adapt morphologically after transplantation. Computer simulation suggested PV grafts to be more susceptible to thrombosis development. Thrombosis of reconstructed PV occurred in four out of five cases in PV group. CONCLUSION: This study supports the use of allografts from caval system for PV reconstruction in clinical medicine when needed.


Assuntos
Simulação por Computador , Pancreaticoduodenectomia , Veia Porta/cirurgia , Veia Cava Inferior/transplante , Aloenxertos , Anastomose Cirúrgica/métodos , Animais , Cadáver , Feminino , Hemodinâmica , Masculino , Tamanho do Órgão , Tratamentos com Preservação do Órgão , Veia Porta/anatomia & histologia , Veia Porta/diagnóstico por imagem , Veia Porta/fisiologia , Complicações Pós-Operatórias/etiologia , Piloro , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fluxo Sanguíneo Regional , Suínos , Coleta de Tecidos e Órgãos , Ultrassonografia , Veia Cava Inferior/anatomia & histologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiologia , Trombose Venosa/etiologia
11.
J Radiol Case Rep ; 13(3): 19-27, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31565174

RESUMO

Spontaneous rupture of the inferior vena cava (IVC) is a rare entity. We report a case of a spontaneous IVC rupture associated with IVC filter thrombosis in a patient presenting with severe atraumatic back pain. Computed tomography (CT) identified a retroperitoneal hematoma and suggested IVC thrombosis. Magnetic resonance (MR) imaging confirmed the presence of IVC filter thrombosis and demonstrated a large defect in the infrarenal IVC, with the vessel lumen in free communication with the adjacent hematoma. The patient was managed conservatively and discharged in stable condition. MR imaging played an important role in characterizing the CT findings, which were unclear.


Assuntos
Ruptura Espontânea/diagnóstico por imagem , Ruptura Espontânea/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/terapia , Tratamento Conservador , Hematoma/complicações , Hematoma/diagnóstico por imagem , Hematoma/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal/diagnóstico por imagem , Ruptura Espontânea/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico por imagem
12.
Braz J Med Biol Res ; 52(10): e8122, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31531523

RESUMO

Ultrasound-measured inferior vena cava (IVC) and abdominal aorta (Ao)-associated parameters have been used to predict volume status for decades, yet research focusing on the impact of individual physical characteristics, including gender, height/weight, body surface area (BSA), and age, assessed simultaneously on those parameters in Chinese children is lacking. The aim of the present study was to explore the impact of individual characteristics on maximum IVC diameter (IVCmax), Ao, and IVCmax/Ao in healthy Chinese children. From September to December 2015, 200 healthy children from 1 to 13 years of age were enrolled. IVCmax and Ao diameters were measured by 2D ultrasound. We found that age (years), height (cm), weight (kg), waist circumference (cm), and BSA (m2) were positively correlated with IVCmax and Ao. Multivariate linear regression showed that age was the only independent variable for IVCmax (mm) in female children, height was the only independent variable for IVCmax in male children, and age was the only independent variable for Ao in both females and males. IVCmax/Ao was not significantly influenced by the subjects' characteristics. In conclusion, IVCmax and Ao were more susceptible to subjects' characteristics than IVCmax/Ao. IVCmax/Ao could be a reliable and practical parameter in Chinese children as it was independent of age, height, and weight.


Assuntos
Aorta Abdominal/diagnóstico por imagem , Ultrassonografia/métodos , Veia Cava Inferior/diagnóstico por imagem , Adolescente , Aorta Abdominal/fisiologia , Grupo com Ancestrais do Continente Asiático , Composição Corporal/fisiologia , Criança , Pré-Escolar , China , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Veia Cava Inferior/fisiologia
13.
Vet Radiol Ultrasound ; 60(6): 680-688, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509893

RESUMO

Computed tomography is increasingly used as a treatment planning method in canine patients with diseases of the retroperitoneum, however, published information on normal variations in the caudal vena cava (CVC) are currently lacking. The objectives of this retrospective descriptive study were to characterize CVC variants using CT angiography in a sample of small breed dogs and localize the CVC bifurcations for each variant. Inclusion criteria were small breed dogs (weight ≤ 15) that underwent contrast-enhanced CT scans of the CVC, abdominal aorta, and CVC tributaries. A total of 121 small breed dogs were sampled. Four right-sided and one left-sided CVC variations were identified: normal (88/121, 72.7%), caudal-partial split (17/121, 14.0%), partial duplication (8/121, 6.6%), complete duplication (7/121, 5.8%), and left-sidedness (1/121, 0.8%). The mean lumbar vertebral levels of the CVC bifurcation were L6.39 ± 0.41, L5.70 ± 0.35, L4.39 ± 0.42, L2.74 ± 0.38, and L6.4 in the normal, caudal-partial split, partial duplication, complete duplication, and left-sidedness types, respectively. The location of the CVC bifurcation, the relationship between the aortic trifurcation and the CVC bifurcation, and the location of the bilateral deep circumflex iliac veins with respect to the CVC bifurcation were significantly different among the right-sided types (P ≤ .001). Bilateral deep circumflex iliac veins joined to the ipsilateral common iliac veins and the CVC in the caudal-partial split and duplication types, respectively. The results of this study indicated that canine CVC variants may be frequent and should be considered during surgery or diagnostic imaging of the retroperitoneum.


Assuntos
Aorta Abdominal/anormalidades , Doenças do Cão/diagnóstico por imagem , Doenças Vasculares/veterinária , Veia Cava Inferior/anormalidades , Animais , Aorta Abdominal/diagnóstico por imagem , Cães , Feminino , Masculino , Linhagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/veterinária , Doenças Vasculares/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem
14.
World Neurosurg ; 132: 58-62, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479791

RESUMO

BACKGROUND: Oblique lumbar interbody fusion takes advantage of the wide interval between the aorta and left-sided psoas muscle to access the lumbar spine, allowing a minimally invasive approach for interbody fusion with lower associated morbidity. As this approach is gaining popularity among spine surgeons, it is important to understand the potential pitfalls that may arise in patients with congenital anomalies of the vascular anatomy. CASE DESCRIPTION: We present a case of a persistent left-sided inferior vena cava (IVC) affecting the side of approach in a patient undergoing lumbar interbody fusion through an oblique prepsoas retroperitoneal approach. Preoperative imaging of our patient revealed a persistent left-sided inferior vena cava with a wide interval between the aorta and the right-sided psoas, allowing us a right-sided oblique approach. CONCLUSIONS: Thorough preoperative imaging evaluation is essential to identify vascular anomalies that may hinder oblique prepsoas retroperitoneal approach to the lumbar spine. Although rare, double IVC or isolated left IVC may complicate the oblique approach.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Malformações Vasculares/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Idoso , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Estenose Espinal/diagnóstico por imagem , Malformações Vasculares/complicações , Veia Cava Inferior/diagnóstico por imagem
15.
Ghana Med J ; 53(2): 181-183, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481815

RESUMO

The inferior vena cava is the most commonly injured abdominal vessel and accounts for about 25% of abdominal vascular injuries. Despite improved preoperative care and operative techniques, the mortality rates for the inferior vena cava injuries are still high due to delayed presentation, inadequate or delayed fluid resuscitation, difficulty of diagnosis and technical problems in repair. A case of the inferior vena cava injury encountered after abdominal stab injury with about 4cm vertical tear of infrarenal vena cava, survived due to immediate transportation, appropriate and successful perioperative fluid and blood resuscitation, prompt surgical management with a team approach and critical post-operative surgical management.


Assuntos
Hematoma/cirurgia , Lacerações/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/lesões , Ferimentos Perfurantes/cirurgia , Duodeno/lesões , Humanos , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Espaço Retroperitoneal , Técnicas de Sutura , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
16.
Braz J Med Biol Res ; 52(9): e8827, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31482978

RESUMO

This study investigated the effects of tidal volume (TV) on the diagnostic value of pulse pressure variation (PPV) and the inferior vena cava dispensability index (IVC-DI) for volume responsiveness during mechanical ventilation. In patients undergoing elective surgery with mechanical ventilation, different TVs of 6, 9, and 12 mL/kg were given for two min. The left ventricular outflow tract velocity-time integral (VTI) was measured by transthoracic echocardiography. The IVC-DI was measured at sub-xyphoid transabdominal long axis. The PPV was measured via the radial artery and served as baseline. Index measurements were repeated after fluid challenge. VTI increased by more than 15% after fluid challenge, which was considered as volume responsive. Seventy-nine patients were enrolled, 38 of whom were considered positive volume responsive. Baseline data between the response group and the non-response group were similar. Receiver operating characteristic curve confirmed PPV accuracy in diagnosing an increase in volume responsiveness with increased TV. When TV was 12 mL/kg, the PPV area under the curve (AUC) was 0.93 and the threshold value was 15.5%. IVC-DI had the highest diagnostic accuracy at a TV of 9 mL/kg and an AUC of 0.79, with a threshold value of 15.3%. When TV increased to 12 mL/kg, the IVC-DI value decreased. When the TV was 9 and 12 mL/kg, PPV showed improved performance in diagnosing volume responsiveness than did IVC-DI. PPV diagnostic accuracy in mechanically ventilated patients was higher than IVC-DI. PPV accuracy in predicting volume responsiveness was increased by increasing TV.


Assuntos
Pressão Sanguínea/fisiologia , Respiração Artificial , Volume Sistólico/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Veia Cava Inferior/fisiologia , Adolescente , Adulto , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Veia Cava Inferior/diagnóstico por imagem , Adulto Jovem
18.
Diagn Pathol ; 14(1): 86, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391089

RESUMO

BACKGROUND: Solitary fibrous tumour (SFT) is a mesenchymal tumour of fibroblastic type, and it develops in almost any part of the human body. However, according to previous studies, the occurrence of intravascular SFTs is extremely rare. CASE PRESENTATION: We reported a case of intravascular SFT in a 67-year-old woman who has been experiencing swelling and pain in the right leg for 2 months. Computed tomography venography scan revealed a well-defined mass obstructing the inferior vena cava (IVC). Surgical resection was performed, and histopathologic and immunohistochemical results were consistent with SFT. Further, next-generation sequencing (NGS) analysis was performed, and results revealed two tumour-related gene mutations (deletion of PMS2 and variation of ESR1 [L536P]). The patient did not receive any adjuvant therapy, and no signs of tumour progression were observed during the 6-month follow-up. CONCLUSION: To the best of our knowledge, this study first presented about SFT arising from the IVC and carried out an NGS analysis to validate the molecular mechanism of such condition.


Assuntos
Edema/patologia , Tumores Fibrosos Solitários/patologia , Veia Cava Inferior/patologia , Idoso , Angiografia por Tomografia Computadorizada/métodos , Edema/diagnóstico , Feminino , Humanos , Flebografia/métodos , Tumores Fibrosos Solitários/diagnóstico , Veia Cava Inferior/diagnóstico por imagem
19.
Methodist Debakey Cardiovasc J ; 15(2): 152-155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384380

RESUMO

Iatrogenic aortocaval fistula is an extremely rare pathologic condition that often results in clinically significant left-to-right extracardiac shunt. In slow-progressing cases, chronic right-sided heart failure can occur and, in some patients, may persist for years. We present a patient with a long-standing aortocaval fistula that was causing high-flow left-to-right shunting, tricuspid regurgitation, severe pulmonary hypertension, and right-side heart failure. After undergoing complete endoscopic isolation of the aortocaval fistula, the patient experienced dramatic clinical improvement and continued to have excellent imaging and clinical resolution after 2 years of follow-up.


Assuntos
Aorta/fisiopatologia , Fístula Arteriovenosa/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Doença Iatrogênica , Veia Cava Inferior/fisiopatologia , Aorta/diagnóstico por imagem , Aortografia/métodos , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Fístula Arteriovenosa/fisiopatologia , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler em Cores , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Desenho de Prótese , Fluxo Sanguíneo Regional , Dispositivo para Oclusão Septal , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
20.
Medicine (Baltimore) ; 98(31): e16679, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374048

RESUMO

RATIONALE: Congenital portosystemic shunt (Abernethy malformation) is a rare entity causing the portal blood to drain directly into the systemic circulation, eluding the liver. These shunts arise through disturbances in the embryonic development. PATIENT CONCERNS: A 9-year-old male patient was referred to our department for further evaluation of a vascular malformation which was diagnosed in another facility when the patient was 2 years old, following a routine abdominal ultrasound. The patient had no complaints and the physical examination was normal at all times. DIAGNOSIS: Laboratory tests and esogastroduodenoscopy were normal. The abdominal ultrasound showed a side-to-side shunt between a short portal trunk and the inferior vena cava. A hepatic mass suggestive for focal noduar hyperplasia was seen in the left liver lobe. Abdominal angio-computed tomography (angio-CT) was performed and the ultrasonographic anomalies were confirmed. Multiple other vascular malformations were diagnosed-hepatic artery emerging from the superior mesenteric artery, with early division; hepatic veins forming a short common trunk before draining into the inferior vena cava; supranumerary right renal artery emerging from the aorta, tributary for the upper renal pole. Ecocardiography showed left superior vena cava persistence. The final diagnosis was Abernathy malformation type IB. In the meantime the patient was diagnosed with allergic asthma. INTERVENTIONS: No surgical cure was pursued because the malformation was an incidental discovery. OUTCOMES: The patient was followed-up closely from the final diagnosis (when he was 9 years old) to present (he is currently 10 years old) with no change in his status-he remained asymptomatic. LESSONS: Angio-CT should be the performed whenever a vascular malformation is suspected in order to establish a correct diagnosis, because portosystemic shunts carry a high risk of severe complications. Knowing that patients with portosystemic shunts may have pulmonary hypertension, respiratory complaints should be carefully evaluated-in this particular case, even though the most probable cause for the respiratory symptoms was pulmonary hypertension, it was ruled out by cardiac ultrasonography and further investigations confirmed the diagnosis of allergic asthma.


Assuntos
Achados Incidentais , Veia Porta/anormalidades , Malformações Vasculares/diagnóstico , Doenças Assintomáticas , Criança , Angiografia por Tomografia Computadorizada , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Veia Porta/diagnóstico por imagem , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem
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