Complications of superior versus inferior vena cava occlusion in infants receiving central total parenteral nutrition

During a 9-year period, 204 infants younger than 12 months of age had 294 Broviac central venous hyperalimentation catheters inserted. Fifty-nine adult-size and 235 infant-size Broviac catheters were used. Catheter insertion was via the saphenous vein (267), external jugular (7), internal jugular (16), cephalic (2), and transthoracic right atrial veins (2). General anesthesia was used for all internal jugular, but for only 11 saphenous catheters. Catheter function ranged from 6 to 925 days (mean, 112 days). Forty-four infants had malabsorption syndromes, 36 had short bowel syndrome, 38 had intractable diarrhea, and 86 required nutritional support for a variety of other conditions. Fifteen of the 204 infants developed inferior (10) or superior vena caval thrombosis (2), or both (3). Thrombosis occurred in 13 of the 267 infants with saphenous catheters (4.9%), and five of the 25 with jugular or cephalic venous catheters (20.0%). Obstruction to normal catheter infusion was the first sign of caval occlusion. Transient mild leg edema (4) and prominent venous pattern over the legs (3) were present with inferior vena caval (IVC) occlusion, but no patient had renal vein obstruction or died as a direct result of this condition. Each of the two patients with superior vena caval (SVC) occlusion experienced mild to moderate edema and venous suffusion of the head and upper extremities, and one developed a pleural effusion. Each of the three infants with combined superior and inferior vena caval thrombosis died from pulmonary insufficiency within six months after SVC occlusion.(ABSTRACT TRUNCATED AT 250 WORDS)     

下腔静脉二次球囊扩张配合华法林治疗合并下腔静脉血栓形成的布加综合征

目的:探讨下腔静脉二次球囊扩张配合口服华法林治疗布加综合征合并下腔静脉血栓形成的临床疗效。方法:回顾分析2008年2月—2014年1月收治的布加综合征合并下腔静脉血栓形成患者54例。先行下腔静脉小球囊扩张术,同时给予达标量口服华法林抗凝治疗3~6个月,影像学观察患者血栓溶解情况。治疗效果明显者给予下腔静脉大球囊扩张成形术。结果:54例患者一期手术成功率100%,2例手术后口服华法令出现出血,改行外科手术治疗;4例改行其他介入治疗方式;余48例患者术后口服华法林抗凝溶栓治疗3~6个月,治疗效果明显,行二次行大球囊扩张治疗。结论:腔静脉二次球囊扩张同时口服华法林治疗布加综合征合并下腔静脉血栓形成有良好的效果。     

Budd-Chiari syndrome and inferior vena cava thrombosis in a nephrotic child

We observed Budd-Chiari syndrome in a boy aged 2 years 6 months with nephrotic syndrome due to hepatic vein and inferior vena cava thrombosis, confirmed by Doppler imaging. Normal values of the routine hemostatic parameters proved that they are of little predictive value for the thrombotic state. Immediate heparin infusion was initiated. High doses of heparin up to 59 IU/kg per hour were required for efficient anticoagulation. A remission of the nephrotic syndrome was achieved with vincristine. Oral anticoagulation with a vitamin K antagonist was continued for 6 months. Doppler imaging then indicated full re-establishment of the blood flow through the affected vessels. The clinical and Doppler data in this case are compatible with acute Budd-Chiari syndrome due to incomplete outflow obstruction of the hepatic veins and inferior vena cava. The favorable outcome was due to the immediate heparin infusion and prompt remission of the nephrotic syndrome. Doppler imaging was an important tool for non-invasive diagnosis and follow-up. Received: 31 May 1999 / Revised: 30 August 1999 / Accepted: 3 September 1999     

Superior sagittal sinus thrombosis and bilateral sixth-nerve palsy in a child with nephrotic syndrome

We report on a patient with nephrotic syndrome who developed superior sagittal sinus thrombosis. He presented with double vision due to bilateral sixth-nerve palsy and papilledema. The thrombosis resolved with intravenous heparin and oral corticosteroids. A month later there were no signs of ocular movement paresis, and both optic nerves were normal.     

兔急性上腔静脉梗阻的安全时限

目的 探讨新西兰大白兔耐受上腔静脉梗阻时间,为临床上腔静脉重建术中阻断安全时限提供依据.方法 新西兰大白兔25只,对照组5只,阻断上腔静脉1 h手术组和2 h手术组各10只,观察上腔静脉压变化,并比较3组术后脑含水量百分比、脑组织的病理学改变.结果 (1)阻断后兔上腔静脉压呈"上升-下降-再上升-维持"过程;(2)阻断1 h组脑含水量与对照组无明显差异,阻断2 h组脑含水量较对照组明显升高,亦较阻断1 h组高;(3)阻断1 h组脑组织结构基本正常,脑细胞病变轻;阻断2 h组可见脑水肿改变,神经元坏死.结论 成功建立急性上腔静脉梗阻动物模型,阻断兔上腔静脉1 h相对安全,阻断2 h以上将产生脑水肿及神经元坏死等改变.     

上腔静脉综合征诊断中支气管内超声引导针吸活检术的应用

目的 探讨支气管内超声引导针吸活检术(EBUS-TBNA)在诊断上腔静脉阻塞综合征(SVCS)中的应用价值.方法 回顾性分析520例中20例SVCS EBUS-TBNA术患者的临床资料,男14例,女6例;年龄35 ～ 77岁,平均(59.1 ±14.6)岁.上腔静脉周围病变短径1.69～9.50cm,平均(3.32±1.79) cm,其中6例隆凸下淋巴结肿大,短径1.73 ～3.01 cm,平均(2.14±0.49) cm.结果 每例穿刺3～5次,平均(4.35±0.75)次.术后病理证实小细胞癌10例,腺癌4例,鳞癌1例,霍奇金淋巴瘤1例.4例穿刺病理未发现恶性证据,其中1例穿刺获取组织量少,2例术前CT显示纵隔占位内有明显钙化考虑良性可能性较大,此3例获取标本抗酸染色及结核分枝杆菌荧光扩增试验阴性,考虑为纵隔炎性病变;另1例因纵隔肿物巨大高度怀疑恶性肿瘤,故而进一步行胸腔镜胸腔活检术,术后病理证实为B细胞源性非霍奇金淋巴瘤.本组EBUS-TBNA对于SVCS病因的诊断率为90.0％ (18/20).结论 EBUS-TBNA是诊断SVCS病因的一种安全有效的方法.     

Superior vena cava thrombosis and chylothorax: relationship in pediatric nephrotic syndrome

We report a 40-month-old black male with nephrotic syndrome who developed chylothorax associated with superior vena cava (SVC) thrombosis. To our knowledge, this is the third reported case of spontaneous SVC thrombosis in a nephrotic patient and the first in which chylothorax was also present. Ultrasonography of the pleura and thoracic vasculature was invaluable in making the diagnosis and monitoring the resolution of this condition during treatment. Contrary to previous reports, thoracic chylous effusions complicating uncontrolled nephrotic syndrome do not originate exclusively as a consequence of abdominal pathology, but rather as this case demonstrates, they can occur from lymphatic obstruction caused by thoracic vein thrombosis. Received January 22, 1996; received in revised form June 17, 1996; accepted June 20, 1996     

Superior sagittal sinus thrombosis in a child with nephrotic syndrome

A 3-year-old male with steroid-responsive nephrotic syndrome developed a rare complication, sagittal sinus thrombosis during an episode of gastroenteritis, while on steroid therapy. Anticoagulation, as assessed by partial thromboplastin time, was difficult to maintain, despite administering high doses of heparin, infusions of fresh-frozen plasma to provide antithrombin III, and, subsequently, maximum doses of warfarin (0.3 mg/kg per day). Despite these problems the child made a complete neurological recovery.     

Inferior vena cava indices determine volume load in minimal lesion nephrotic syndrome

The pathogenesis of edema in nephrotic syndrome has not been entirely understood. We investigated the value of the echographic parameters [inferior vena cava index (IVCI), inferior vena cava collapsibility index (IVCCI), and left atrium diameter (LAD)] to determine the volume load in children with minimal lesion nephrotic syndrome (MLNS). Twelve children with MLNS (seven boys, five girls) were included in this study. The patients were classified into three different stages (stage A: edematous; stage B: 50% decrease in weight gain; stage C: edema free) following measurement of their ideal weights. The ideal weight of patients in stage A was increased 13 +/- 7%. Serum total protein, albumin and urine sodium levels were found to be low in these patients. Plasma renin activity (PRA) and serum aldosterone levels in stage A were significantly different from those of the control group (P<0.05). PRA and serum aldosterone levels were not different from those of the control group in stage B (P>0.05). However, the increase in PRA was significant in stage C. Although a significant weight decrease was found in stages B and C, it had no effect on IVCI, LAD, and cardiothoracic index. We consider IVCI, IVCCI, and LAD measurements by echocardiography (ECHO) to be easy and reliable clinical methods for assessing the intravascular volume load in patients with MLNS.     

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.     

Superior vena cava syndrome due to a leiomyosarcoma of the anterior mediastinum: A case report and literature overview

INTRODUCTION

Leiomyosarcomas are an infrequent cause of malignant superior vena cava syndrome (VCS).

PRESENTATION OF CASE

A 51-year old male patient was admitted for a three-day history of dyspnoea, dysphagia and erythema of the head and neck. Computed tomography and magnetic resonance imaging showed a lesion arising on the anterior mediastinum, which was in close proximity with a thrombus in the superior vena cava. Surgical excision was performed, including open resection of the primary tumour and an atrio-innominate vein bypass with 8-mm polytetrafluoroethylene (PTFE). Histology confirmed a leiomyosarcoma and postoperative radiotherapy sessions were performed. Due to evidence of enlargement of the thrombus, a second intervention was undertaken. In this procedure, a remainder of the primary tumour was resected and the superior vena cava reconstructed with an autologous pericardium patch. The patient recovered satisfactorily and was discharged on the seventh postoperative day, with no evidence for relapse after 10 months of follow-up.

DISCUSSION

Leiomyosarcomas comprise less than 2% of the tumours of the mediastinum and are a rare cause of paraneoplastic VCS. Male patients in their sixties are most commonly affected. Relapses seem to be common, and thus a careful follow-up is often recommended.

CONCLUSION

In spite of the limited data on the management of thoracic leiomyosarcomas, surgery is currently considered the mainstay of treatment.     

Deep venous thrombosis caused by congenital absence of the inferior vena cava: Report of a case

Although anomalies of the inferior vena cava (IVC) are seen frequently in a clinical setting, congenital absence of the IVC (AIVC) is rare. However, anomalies of the IVC should be considered in young patients suffering from recurrent and idiopathic DVT. We report a case of DVT possibly caused by AIVC in a 27-year-old man, and discuss the clinical features, diagnosis, and treatment of this unusual entity.     

Superior vena cava obstruction and liver transplantation in a child

We report a case of superior vena cava obstruction in a child, which was probably secondary to long-term central venous cannulation. The obstruction was asymptomatic preoperatively, but became evident during liver transplantation, and complicated the intraoperative management. There is one other case report of this occurring in an adult in similar circumstances, and we believe that ours is the first report of such a presentation in the paediatric age group.     

肝癌合并下腔静脉癌栓的外科治疗

肝癌合并下腔静脉癌栓的治疗仍是医学难题,一直被视为手术禁忌证.患者主要接受非手术治疗或放弃治疗,其生存率较低.近年来随着医学的进步,手术治疗肝癌合并下腔静脉癌栓的成功率逐年增高.201 1年5月哈尔滨医科大学附属第二医院为1例肝癌合并下腔静脉癌栓患者行肝脏Ⅴ、Ⅶ、Ⅷ段切除＋下腔静脉癌栓取出术.术前CT检查示肝Ⅴ、Ⅶ、Ⅷ段占位性病变,下腔静脉内癌栓充盈,三维重建测算左半肝体积489 cm^3,低于最小存活肝脏体积.为了最大限度保留剩余肝脏,拟行保留肝Ⅵ段的右半肝切除术,于全肝血流阻断下腔静脉癌栓取出术.患者术后恢复良好,术后18个月复查未见明显复发转移症状.     

Scimitar syndrome with an accessory diaphragm and an absent right superior vena cava

An 8-year-old boy with scimitar syndrome, an accessory diaphragm and an absent right superior vena cava, underwent surgery on March 28, 1983. The scimitar vein was separated from an accessory diaphragm and cut just above the right diaphragm where the vein penetrated. The vein was re-implanted into the right lateral portion of the right atrium and a tunnel was made between the atrial septal defect created in the septum and the site of the implanted vein. The accessory diaphragm was not removed because of the lack of compression on the right lung. At cardiopulmonary bypass, venous cannulae were inserted into the persistent left superior vena cava and inferior vena cava. Because of the absence of the right superior vena cava, the right atrium was not fixed by both cavae so that there was difficulty in intracardiac maneuvers. The patient is doing well 32 months after this treatment.     

纵隔镜在上腔静脉阻塞综合征诊断中的应用

目的探讨纵隔镜在上腔静脉阻塞综合征（SVCOS）病因诊断中应用的可行性和价值。方法12例上腔静脉阻塞综合征病人，男9例，女3例；年龄16，71岁，平均45．2岁。行颈部纵隔镜检（CM）7例，胸骨旁纵隔镜检（PSM）5例。结果11例获得病理学诊断，阳性率91．7％。其中原发肺癌8例，淋巴瘤3例，未能明确诊断1例；所有病例手术经过均顺利，无并发症和死亡；1例淋巴瘤术后症状加重，化疗后缓解。结论纵隔镜检查对于SVCOS病例同样安全可靠，可作为其他方法不能确诊病例的可靠检查方法。     

Malignant solitary fibrous tumor with superior vena cava syndrome

Mediastinal solitary fibrous tumors, particularly those that are malignant, are rare. We report a case of malignant solitary fibrous tumor with superior vena cava syndrome and highly aggressive behavior. Postoperative radiotherapy was performed due to incomplete resection, but the tumor relapsed within 4 months. Gemcitabine-based chemotherapy was ineffective.