Leiomyosarcoma of the inferior vena cava

BACKGROUND: The inferior vena cava is an uncommon location for leiomyosarcoma, a malignant tumor which develops from the smooth muscle tissue of the media. CASE REPORT: A 76-year-old woman was hospitalized for swelling of the lower limbs. Ultrasonography, computed tomography of the abdomen and magnetic resonance imaging showed tumoral invasion of the inferior vena cava extending to the atrium. Histology examination of a tumoral fragment obtained by transjugular catheterism affirmed the diagnosis of leiomyosarcoma. DISCUSSION: Prognosis of leiomyosarcoma of the inferior vena cava is very poor. No medical or surgical treatment has given satisfactory results. Two factors would explain the poor prognosis: the tumoral localization and the low degree of tumoral differentiation. Clinical presentation and imaging findings suggest the diagnosis which must be confirmed by pathology examination of a tumoral biopsy specimen.     

Leiomyosarcoma of the inferior vena cava

1. The effects of graded dietary concentrations of cholestyramine (CSTY, a bile acid binding polymer), which prevents micelle formation and bile acid reabsorption, on the lipid and energy metabolism of chicks given diets containing different dietary concentrations of medium chain triacylglycerol (MCT) and long chain triacylglycerol (LCT) were investigated. 2. MCT- or LCT-supplemented diets containing 100 or 200 g oil/kg diet and 0, 10 or 20 g CSTY kg were fed to 7 d old chicks for 10 d. As dietary CSTY concentration increased, a reduction in the metabolisable energy value was observed for both dietary lipid sources. Consequently, fat and energy retentions were also reduced as the dietary CSTY content increased.     

A case of superior vena cava syndrome caused by Klebsiella pneumoniae

A 27 yr old man presented with productive cough, fever and manifestations of superior vena cava syndrome. He was an alcoholic but had been in good health until 3 days prior to admission. The physical examination, the chest radiograph and the results of the sputum culture were compatible with Klebsiella pneumoniae pneumonia of the right upper lobe. The superior vena cava scintigram using technetium-99m showed near total occlusion of the superior vena cava, while sputum cytology, chest computed tomography, and bronchoscopy were all negative for malignant aetiology. Antibiotic therapy brought about slow resolution of the pneumonia and also of the superior vena caval obstruction. The follow-up scintigram showed normalized venous flow of the superior vena cava. To our knowledge, this is the first case of superior vena cava syndrome developed in probable association with Klebsiella pneumoniae pneumonia.     

Leiomyosarcoma of the inferior vena cava. Diagnosis and surgical management

Leiomyosarcoma of vascular origin are rare tumors arising most frequently from the inferior vena cava (IVC). We report on three patients one of whom underwent definitive resection. These tumors most commonly involve the upper segment of the IVC, and appear with manifestations of the Budd-Chiari syndrome. Lesions at this level are not amenable to surgical therapy. Tumors of the middle and lower segments of the IVC usually cause right-sided pain. Diagnosis is difficult, but is best approached preoperatively by angiography and vena cavography. Optimal therapy of lesions at these levels is surgical resection. Resection of the IVC below the hepatic veins is possible with renal function preserved by collateral drainage of the left renal vein.     

Leiomyosarcoma of the inferior vena cava and magnetic resonance imaging

Venous leiomyosarcomas are rare and predominantly arise in the inferior vena cava (IVC). The clinical findings, often not very suggestive and nonspecific, sometimes precede the diagnosis by several years. According to the literature, leiomyosarcoma of the IVC generally occurs in middle-aged women. Modern imaging techniques, especially magnetic resonance imaging (MRI) can now establish the diagnosis of leiomyosarcoma of the IVC with a high probability and allow assessment of operability. The authors report a case of leiomyosarcoma of the IVC in a 24-year-old male patient, confirmed by intravenous biopsy. They present the MR features of this malignant tumour, rarely reported in the literature, and emphasize the value of this examination in the operability staging. The 3D imaging provided by MRI allows intra and extraluminal staging and involvement of adjacent organs. It also allows optimal evaluation of the effects on flow, circulatory slowing or thrombosis and, due to its high contrast resolution, it is more sensitive to distinguish clot from tumour nodule.     

Etiologic prevalence of superior vena cava syndrome

OBJECTIVES: Superior vena cava syndrome (SVCS) is an uncommon disease which receives usually bad prognostic. In order to study the prevalence of the different etiologies we have reviewed retrospectively 17 documented cases of SVCS in the last 5 years. METHODS: The range of age was between 43 and 80 years Sex distribution was 16 males and 1 female. RESULTS: Malignant pathology was by large the most common etiology. Oat cell and squamous cell carcinoma account each for 20%, adenocarcinoma for 18%, undifferenciated carcinoma for 12% and Hodgkin's disease for 6%. Among the benign causes we have found a case of retroesternal goiter.     

Primary malignant lymphoma of superior vena cava

A 78-year-old woman suffered from superior vena cava (SVC) syndrome. Computed tomography and angiography revealed a mass within the SVC. The SVC was resected via median sternotomy, followed by reconstruction using an artificial graft. The resected specimen showed a polypoid tumor within the SVC that had invaded the wall of the SVC. Histologic diagnosis was diffuse large-cell non-Hodgkin's lymphoma. Most surrounding lymph nodes showed reactive swelling, but one showed a partial microscopic metastasis. These pathologic findings indicated that the tumor was an SVC-originating malignant lymphoma. The patient is now alive and tumor-free 65 months after the operation.     

Diagnosis and management of superior vena cava syndrome

Superior vena cava (SVC) syndrome is a relatively common complication of lung cancer or lymphoma, and in fact is often the initial manifestation of these diseases. However, benign causes also exist, and physicians should not automatically assume that SVC syndrome is due to cancer. A definitive histologic diagnosis of cancer should be obtained before starting radiotherapy or chemotherapy to treat SVC syndrome.     

Computed tomography-guided central venous catheter placement in a patient with superior vena cava and inferior vena cava occlusion

Erythropoietin (EPO) is a glycoprotein hormone produced principally by the kidney and is the major stimulus for erythropoiesis. Recombinant human EPO has now been biosynthesized and is available for clinical use, particularly in patients with renal failure. EPO has been reported to be effective in treating anaemia due to chronic renal failure. It has been used in pregnancy to correct anaemia following renal transplantation with graft dysfunction. We report here the case of a post-renal transplant patient who became pregnant and developed severe anaemia which was not related to iron, B12, or folate deficiency. Her anaemia was successfully treated with EPO with no evidence of rejection or significant graft dysfunction following therapy. She tolerated EPO very well, and there was a successful outcome of the pregnancy. This case has encouraged us to conclude that EPO has a useful role in the treatment of anaemia in pregnant women following renal transplantation.     

VDD pacing in persistent left superior vena cava

Although persistent left superior vena cava (PLSVC) is the most common major venous anomaly of the heart, associated absence of the right superior vena cava with normal visceral situs is exceedingly rare. Such a patient presented with complete heart block requiring permanent pacing. This was achieved successful using a single lead VDD system via the PLSVC with atrial sensing in the coronary sinus.     

Acute superior vena cava syndrome caused by benign goiter

The authors present a patient at old age with acute superior caval vein syndrome caused by a large benign goitre. Surgical treatment gave a very good early result and a very good late one, inspite of numerous additional burdens subsequent to biological condition of the operated patient.     

Ten-year follow-up of a patient with pacemaker induced superior vena cava syndrome

A woman with persistent pacemaker induced superior vena cava syndrome was stable for 10 years. Serial follow-up venography, however, demonstrated a continuous process of major vein occlusion and the development of collateral circulation, the effectiveness of which warrants a favorable prognosis in this pacemaker related syndrome.     

Anomalous drainage of right superior vena cava into the left atrium

Tracheal glomus tumors are extremely rare. We present herein the case of a 43-year-old man with hoarseness who was found to have a glomus tumor arising from the lower trachea. Bronchoscopy and chest computed tomography revealed a polypoid mass in the membranous portion of the trachea just above the carina. The patient underwent successful tracheal sleeve resection and reconstruction. A pathologic diagnosis of a glomus tumor with clear surgical margins was subsequently confirmed, and the patient is well 20 months postoperatively with an intact anastomosis.     

Suspected superior vena cava syndrome: the role of the Swan-Ganz catheter

The use of the Swan-Ganz flow-directed catheter in establishing the diagnosis of the superior vena cava syndrome in two patients (one with Hodgkin's disease and the other with carcinoma of the lung) is described. A pressure tracing showing elevated pressure above the obstruction without respiratory or cardiac fluctuations is characteristic of obstruction of the superior vena cava.     

Study of superior vena cava syndrome--aetiopathology, diagnosis and management

Thirty two patients of superior vena cava syndrome (SVCS) were studied. Clinical features noted were diffuse neck swelling, breathlessness, chest pain, engorged neck veins, facial swelling and dilated engorged veins over chest wall. Radiography revealed a superior mediastinal mass in 31.2% of patients and right upper lobe mass in 50% patients. FNAC of lung showed aetiology in 34.5% patients and lymph node biopsy in 31.2% patients. Aetiology of SVCS was benign in 12.5% patients and malignant in 87.5% patients. Squamous cell carcinoma was the commonest cause of SVSC. Radiotherapy proved to be the most beneficial form of treatment. The mean survival period in patients due to malignant etiology was 6 months.     

Discovery of left-sided superior vena cava during central venous catheterization

PURPOSE: To report a child with the mitochondrial cytopathy of Pearson syndrome and zonular cataract. METHOD: Case report. We describe a 6-year-old boy with Pearson syndrome. RESULTS: At age 3 years, the boy developed secondary strabismus caused by bilateral zonular cataract. Subsequently, he underwent successful bilateral cataract extraction with intraocular lens implantation. Postoperative visual acuity with best correction was RE, 20/25 and LE, 20/40. CONCLUSIONS: Children with Pearson syndrome should be examined ophthalmologically to rule out zonular cataract and possible amblyopia. Mitochondrial cytopathies such as Pearson syndrome should be included in the differential diagnosis of congenital and early juvenile cataract.     

Catheter-induced thrombus in the superior vena cava diagnosed by transesophageal echocardiography

BACKGROUND: To present the role of transesophageal echocardiography (TEE) in the diagnosis and management of catheter-related superior vena cava thrombosis. CASE HISTORY: A 42-year-old woman with severe Crohn's disease presented with septic shock and pulmonary embolism three weeks after emergency laparotomy and ileocolic resection for small-bowel perforation with peritonitis. Cardiopulmonary evaluation with ECG, pulmonary artery catheter and TEE demonstrated no evidence of acute myocardial ischemia or ventricular dysfunction; hemodynamic indices were consistent with severe sepsis. TEE revealed a large sheathing thrombus surrounding a central venous catheter used for parenteral nutrition. A spiral CT scan of the chest confirmed multiple peripheral pulmonary emboli. Treatment consisted of systemic anticoagulation and antibiotics. To avoid further pulmonary embolism, the central venous catheter was not removed until six days later under TEE monitoring, which revealed that the thrombus was firmly adherent to the superior vena cava. The patient made an uneventful recovery and was discharged from hospital on long-term anticoagulant therapy. CONCLUSION: In a case of catheter-induced superior vena cava thrombosis with septicemia and pulmonary embolism, bedside TEE was very helpful to make the correct diagnosis early, assess thrombus size during anticoagulation, and monitor cardiac performance and thrombus disposition during central venous catheter removal.