CT appearance of calcified tumor thrombus in the inferior vena cava

We report the unusual occurrence of calcined tumor thrombus in the inferior vena cava (IVC) in a patient with renal cell carcinoma diagnosed by computed tomography (CT).     

Endovascular therapy for floating thrombus in the inferior vena cava

ObjectiveWe aimed to summarize the clinical characteristics of floating thrombus in the inferior vena cava (IVC).MethodsFrom January 2014 to June 2019, four patients with floating thrombus in the IVC were admitted to our hospital and underwent intracavitary therapy. Diagnosis, therapy, and clinical characteristics of floating thrombus were summarized.ResultsThree patients presented with pulmonary embolism. Three of the patients had a floating thrombus discovered by inferior venacavography and one was found by contrast-enhanced computed tomography. Two patients had deep venous thrombosis in the lower extremities. One patient had a double IVC, one had left iliac vein compression syndrome, and one had right renal phlebothrombosis. The four patients underwent implantation of a temporary IVC filter and were treated with anti-coagulation, debulking, and thrombolysis. All four patients achieved satisfactory results.ConclusionsFloating thrombus in the IVC is often caused by spread of branch vein thrombosis, and is more likely to lead to pulmonary embolism. Anti-coagulant therapy and debulking under the protection of filters can achieve satisfactory clinical results.     

Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium

Tumor thrombus (TT) in the inferior vena cava (IVC) and right atrium (RA) is rarely encountered. We have diagnosed before death and treated a case of hepatocellular carcinoma (HCC) with TT in the IVC and RA, accompanied by a brain metastasis. The image characteristics on computed tomography (CT), magnetic resonance imaging (MRI), and conventional angiography are discussed.     

Intraoperative transesophageal sonographic monitoring of tumor thrombus in the inferior vena cava during radical nephrectomy and thrombectomy for renal cell carcinoma

We report the case of a 58-year-old woman with renal cell carcinoma in whom real-time transesophageal sonographic monitoring of the tumor thrombus in the inferior vena cava provided dynamic information, allowing us to determine the appropriate operative procedure to use. Observation of the thrombus throughout the operation showed that mobilization of the liver resulted in compression of the inferior vena cava against the spine, increasing the risk of migration of the tumor thrombus and reinforcing the need to maintain adequate positioning of the liver to prevent such compression. The surgery was completed successfully, and the patient's postoperative course was uneventful. We recommend the use of real-time transesophageal sonographic monitoring of the tumor thrombus during such surgical procedures.     

肾癌伴下腔静脉癌栓27例围术期护理

目的:探讨肾癌伴下腔静脉癌栓患者围术期的护理方法.方法:对27例肾癌伴下腔静脉癌栓患者做好术前、术中及术后护理.结果:本组痊愈出院26例,死亡1例.结论:对肾癌伴下腔静脉癌栓患者进行完善的围术期护理,可提高手术成功率,降低并发症的发生,改善患者生存质量.     

Sonographic appearance of an advanced invasive mole and associated metastatic thrombus in the inferior vena cava

We present a case of an advanced invasive mole with a metastatic thrombus in the inferior vena cava in which sonography clearly showed vesicles in the myometrium, ovaries, and metastatic thrombus leading to a diagnosis of invasive mole rather than choriocarcinoma. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound, 2013.     

Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report

BACKGROUNDAcute pulmonary embolism (APE) is a rare and potentially life-threatening condition, even with early detection and prompt management. Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARYA 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava (IVC) tumor thrombus. APE that occurred during tumor thrombectomy with hypercapnia and desaturation. The capnography combined with the transesophageal echocardiography (TEE) provided a crucial differential diagnosis during the operation. The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability. He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist. There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSIONUnder general anesthesia for IVC tumor thrombus surgery, a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE, which occurs before hemodynamic changes. When intraoperative APE is suspected, TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram. Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.     

术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值

目的探讨术前及术中超声造影对下腔静脉癌栓是否合并血栓的诊断价值。 方法选取2017年10月至2019年3月解放军总医院收治的发现肾肿瘤伴下腔静脉癌栓并行腹腔镜手术治疗的患者60例，所有患者均于术前及术中行超声造影检查，以典型增强模式判断癌栓是否合并血栓，并最终取得术后病理结果。以术后病理结果为"金标准"，计算术前及术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值和阴性预测值。 结果60例下腔静脉癌栓患者均接受了机器人辅助腹腔镜下根治性肾切除联合下腔静脉内癌栓切除术。根据病理结果，下腔静脉癌栓合并血栓者10例（16.7%），其中术前超声造影漏诊2例，另有2例癌栓头部坏死组织被术前及术中超声造影误诊为血栓。术前与术中超声造影评估癌栓合并血栓的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为80.0%、96.0%、93.3%、80.0%、96.0%和100.0%、96.0%、96.7%、83.3%、100.0%。 结论术前及术中超声造影对下腔静脉癌栓是否合并血栓有较好的鉴别诊断效能，可为手术方式的选择提供重要信息和依据，具有较高的临床应用价值。     

肾癌腔静脉癌栓20例诊治体会

目的提高肾肿瘤合并下腔静脉癌栓的诊治水平。方法收集我院自1996年1月至2006年2月收治的20例肾癌合并腔静脉癌栓患者临床资料并进行随访分析。结果术前影像学诊断均无区域淋巴结或远处转移，通过超声、CT或MRI明确有腔静脉癌栓，膈上型1例；膈下型19例，其中肾静脉型11例，肝下型5例，肝内型3例。19例患者手术成功，1例术中死亡。术后病理分期（Robson分期）ⅢA期19例，ⅢC期1例。术后病理透明细胞癌17例，孔头状腺癌2例，血管平滑肌瘤1例。18例获得术后随访4～70月，平均38个月，2例分别于术后18、23个月因癌死亡，16例无瘤生存。结论手术是肾癌合并腔静脉癌栓的有效治疗方法，提高手术技巧和围手术期处理可增加手术的安全性。     

肾癌伴腔静脉癌栓住院患者的健康教育及护理体会

目的探讨肾癌伴下腔静脉癌栓患者围手术期的护理方案。方法回顾性分析19例确诊为肾癌合并下腔静脉癌栓患者的临床资料,制定严密的护理方案,对肾癌伴腔静脉癌栓患者术前、术后采取一系列有效的护理措施,加强巡视和观察。结果经护理,患者均顺利出院。结论肾癌伴下腔静脉癌栓患者围手术期采取有效的护理措施,对于促进患者早日康复及降低术后各种并发症的发生率有非常重要的作用。     

手术治疗肾癌合并下腔静脉瘤栓

目的评价手术治疗肾细胞癌合并下腔静脉瘤栓的疗效。方法回顾分析38例经手术治疗的肾细胞癌合并下腔静脉瘤栓患者的临床资料。结果 38例患者中,男28例,女10例,平均年龄56岁;右肾癌伴腔静脉瘤栓31例,左肾癌伴腔静脉瘤栓7例;Ⅰ级瘤栓8例,Ⅱ级24例,Ⅲ级3例,Ⅳ级3例。所有患者均行肾癌根治切除及取瘤栓术,其中35例下腔静脉阻断下切除下腔静脉瘤栓,3例瘤栓达右心房,在体外循环腔静脉心房分流下取瘤栓。围手术期无死亡病例。随访6～114个月,平均41个月,21例无瘤生存（55.2%）,2例复发转移带瘤生存（5.2%）,13例肿瘤转移死亡（34.2%）,2例失访。结论没有转移的肾细胞癌合并下腔静脉瘤栓如能完整切除,并非手术禁忌和愈后不良的因素。     

原发性肝癌合并肝静脉、下腔静脉或右心房瘤栓的诊治

目的探讨原发性肝癌合并肝静脉瘤栓（HVTT）、下腔静脉瘤栓（IVCTT）或右心房瘤栓（RATT）的影像学特点和介入、手术切除的治疗效果.方法对20例肝癌患者的临床资料进行总结和分析.结果 HVTT＋IVCTT＋RATT 9例,HVTT＋IVCTT 9例,HVTT＋RATT 1例,IVCTT＋RATT 1例.16例行肝动脉造影,提示15例瘤栓为肝动脉供血.15例行肝动脉化疗栓塞,其中2例行Ⅱ期切除＋IVCTT摘除术,1例介入前行肝癌局部高温固化术.生存时间为7 d～75个月,中位生存期为10个月.结论 HVTT、IVCTT和RATT的诊断主要依据综合影像学检查.由于瘤栓的肝动脉供血的特点,肝动脉化疗栓塞可使其坏死、缩小甚或消失.对肝癌病灶较局限、肝功能良好和肺部无转移的患者,肝动脉化疗栓塞可明显延长其生存期.少数患者可争取Ⅱ期切除.     

Renal angiomyolipoma with coexistent hemorrhagic aneurysm formation and fatty thrombus in inferior vena cava: a rare presentation

Angiomyolipoma (AML) is known as the most common benign mesenchymal tumor of kidney. Usually AMLs present as benign lesions without local invasion or complication. However, few cases of renal AML have been reported with complications such as tumor thrombus extension into inferior vena cava (IVC) or hemorrhagic aneurysm formation. We report a complicated case of renal AML with CT and angiography evidence of hemorrhagic aneurysm formation and IVC thrombus, treated by a combination of selective arterial embolization, radical nephrectomy and thrombectomy. Radiologists and clinicians should be aware that AMLs could have such aggressive behaviors.     

肾癌并肝下型下腔静脉癌栓的手术治疗并文献复习

目的探讨肾细胞癌并下腔静脉癌栓的手术治疗方法。方法回顾性分析6例经手术及病理证实的肾细胞癌并肝下型下腔静脉癌栓患者的临床资料,所有病例均行根治性肾切除并癌栓切除术,分别采用下腔静脉切开、下腔静脉部分切除和节段性下腔静脉切除三种方法取出癌栓。结果 6例手术均获成功,无大出血、肺梗塞等并发症,术后患者恢复良好。其中2例分别于术后38个月和76个月死亡,3例仍健在,平均存活时间为54个月,1例术后18个月后失访。结论右肾癌并下腔静脉癌栓患者下腔静脉节段性切除能够安全地进行,根治性肾切除并癌栓切除术能够使患者获得长期存活。     

下肢深静脉血栓病人放置下腔静脉滤器的护理

经皮放置下腔静脉滤器已问世30多年，经过不断改进，现已成为预防下肢深静脉血栓（DVT）后导致肺栓塞（PE）的有效方法，也是溶栓、取栓术或静脉血管成形术或支架术的安全保证措施之一。我院自2003年7月-2004年11月为34例DVT病人放置了下腔静脉滤器，然后再对栓塞的血管进行介入治疗，效果满意，现报告如下。     

肾癌伴下腔静脉癌栓的手术治疗

目的探讨手术治疗肾癌伴下腔静脉癌栓的效果。方法回顾性分析2004年10月至2006年3月共5例肾癌伴下腔静脉癌栓患者的临床资料,男3例,女2例,平均49.8岁。5例均为右侧,肾静脉型(Ⅰ型)1例,肝下型(Ⅱ型)2例,肝内型(Ⅲ型)2例。均行肾癌根治性切除加下腔静脉切开取栓术。结果1例因癌栓脱落引起肺栓塞术中死亡外,余4例手术顺利。1例癌栓侵犯腔静脉壁,术后局部复发和肺部转移,17个月死亡。其余3例分别随访7个月、9个月、23个月,均未发现肿瘤复发和远处转移。结论对于未发现有远处转移的肾癌下腔静脉癌栓,肾癌根治性切除加下腔静脉切开取栓术是积极有效的治疗方法。