Variations in Azygos Venous System in The Eastern Indian Population: A Cadaveric Study

Background: This study aimed to classify Azygos vein patterns in the Eastern Indian population. Methods: During the routine dissection of MBBS in the 2018–2020 academic year, 20 formalin embalmed cadavers aged 50–70 were used to classify the azygos system. The cadaver’s age was verified by its entry into our institute’s anatomy register. The register confirmed that all cadavers used for dissection were of Indian origin. Though gender was not compared in this study, it was noted for record purposes by identifying the external genitalia and confirming it to the records. These were the exclusion criteria: 1) No major thoracic surgeries; 2) No major thoracic deformities. Azygos, hemiazygos, and accessory hemiazygos veins were also examined. Results: The Anson & McVay system was used to classify the recruited cadavers’ azygos system. The cadavers were classified into Type-1, Type-2, and Type-3. Type 2 was again subdivided into 5 subgroups and Type-3 into2 sub-groups. In one cadaver, Type-1 was observed, 17 cadavers had Type-2 azygos system and 2 cadavers showed Type-3. Of the 17 cadavers of Type-2, 3 and 7 cadavers had Type-2A and -2B, respectively. Similarly, 4 and 1 cadavers had 2C and 2D patterns, respectively. Also, 2 cadavers showed 2E type. Of the 2 cadavers of Type-3, one was Type -3A and one Type-3B. The termination of the azygos vein vertebral level was between T2 and T4, of the hemiazygos vein was T8 to T11, and accessory hemiazygos veins were between T7 and T10. Conclusion: These variations should be well studied to avoid misinterpretation during radiological investigations and surgical interventions.

Large posterior mediastinal goiter post total cervical thyroidectomy: a case report

Thoracotomy approach is indicated for a complete and safe posterior mediastinal goitre removal. A 68 years old male was hospitalized due to a right mediastinal mass found in a chest X-ray and confirmed by computed tomography. The patient had undergone total cervical thyroidectomy thirty years ago. A computed tomography (CT) guided percutaneous needle biopsy of the mass revealed thyroid tissue. Subsequently, the mass was completely resected through a right posterolateral thoracotomy. The histopathology confirmed a large mediastinal goitre with no signs of malignancy. The patient had an uncomplicated recovery. We present a relatively rare case of a successful resection of a posterior mediastinal goitre, occurring thirty years post-total cervical thyroidectomy. We advocate lateral thoracotomy to achieve a broad operative field and enhance surgical safety.

Schwannomas mediastinal y retroperitoneal metacrónicos / Metachronous mediastinal and retroperitoneal schwannomas

Los schwannomas, también llamados neurilemomas, son tumores originados en la vaina de los nervios periféricos. El 45% ocurren en cabeza y cuello, solo el 9% en mediastino y el 0,7-2,7% en retroperitoneo. La multicentricidad es extremadamente rara. Presentamos el caso de un paciente de 30 años que consultó por dolor torácico derecho asociado a derrame pleural, al que se le diagnosticó un schwannoma mediastinal posterior, el cual fue resecado en forma completa por cirugía videoasistida. A los 3 años, vuelve a consultar por dolor en flanco derecho y, al estudiarlo, se constata un nuevo schwannoma de localización retroperitoneal, que se resecó por vía abierta dada su posición retrocava. Describimos la metodología de estudio de esta neoplasia y los hallazgos histopatológicos que demostraron su benignidad. Conclusión: es una patología muy infrecuente pero con excelente pronóstico posoperatorio si la resección quirúrgica es completa.

Schwannomas, also known as neurilemmoma, are neurogenic tumors that arise from the peripheral nerve sheaths. Forty-five percent of schwannomas occur in the head and neck, 9% in the mediastinum and 0.7-2.7% in the retroperitoneum. Multiple shwannomas are extremely rare. We report the case of a 30-year old male patient with chest pain in the right hemithorax associated with pleural effusion due to schwannoma of the posterior mediastinum that was completely resected with video-assisted thoracoscopy. Three years later, he presented pain on the right lumbar region due to a retroperitoneal schwannoma behind the vena cava that was completely removed with open surgery. We describe the tests used to evaluate this tumor and the histopathological findings confirming its benign nature. Conclusion: Schwannoma is a rare condition with excellent postoperative outcome after complete surgical resection.

Neurofibromatosis sin neurofibromas con tumor mediastinal como forma de debut / Neurofibromatosis without neurofibromas. Case report with a mediastinal tumor as the first sign of the disease

Se presenta paciente con historia familiar de neurofibromatosis (NF) tipo I, con síntomas y signos sugestivos de esta enfermedad que refiere dolor torácico paravertebral izquierdo al cual mediante estudios de imagen se le diagnostica lesión tumoral en mediastino posterior. Es de notar la presencia de manchas cutáneas características de la neurofibromatosis, localizadas solo en un dermatoma del cuerpo sin neurofibromas en ninguna otra localización. Se intervino quirúrgicamente el enfermo, se resecó una gran masa mediastinal que se confirmó histológicamente ser un neurofibroma. La evolución posquirúrgica fue satisfactoria. Se discuten las singularidades de este enfermo sobre la base de criterios diagnósticos de neurofibromatosis tipo I, pero sin neurofibromas periféricos hasta ese momento. La posibilidad de una neurofibromatosis segmentaria tampoco se descarta. Se hace énfasis en la necesidad de resección de cualquier lesión tumoral en el contexto de este síndrome genético por la frecuencia de lesiones malignas asociadas a la neurofibromatosis y a la progresión hacia la malignidad de lesiones primariamente benignas(AU)

A patient with a family history of Neurofibromatosis type I was presented. The patient referred symptoms and signs suggestive of that disease and complaint of left paravertebral chest pain. Imaging investigations were done and a posterior mediastinal tumor was diagnosed. It is important to highlight the presence of characteristics spot of neurofibromatosis localized only in one dermatome without neurofibromas in any other part of the body. The patient underwent a surgical intervention and a left thoracotomy was done, a large posterior mediastinal tumor was found and totally resected. The histology confirmed a neurofibroma. The postoperative evolution was satisfactory. The singularities of this patient were discussed, especially diagnosis criteria for neurofibromatosis type I, and the lack of peripheral neurofibromas until that moment. The possibility for a segmental neurofibromatosis also was considered. We pointed out about the necessity to remove any neoplastic lesion in the background of this genetic syndrome due to the high frequency of malignancies associated with neurofibromatosis, and also related with the malignant degeneration these tumors can develop(AU)

Massive thymoma of the mid-posterior mediastinum: an unprecedented case in a young adult / Timoma volumoso de mediastino medioposterior em adulto jovem: relato de caso inédito

Abstract We report an unprecedented case of ectopic thymoma in a young adult. A 33-year-old male presented with a 10-day history of non-productive cough and fever. Investigation revealed mediastinal widening without pulmonary involvement. Computed tomography showed a large mass-14.8 × 10.8 × 8.4 cm-in the mid-posterior mediastinum, and a biopsy obtained by video-assisted thoracoscopy indicated that the mass was a tumor. Immunohistochemistry showed combined thymoma type AB1. Because of the considerable proportions of the tumor and its close proximity to major structures, the patient was treated with chemotherapy.

Resumo Apresentamos caso inédito de volumoso timoma ectópico em adulto jovem. Homem de 33 anos de idade, encaminhado com tosse seca e febre diária havia 10 dias. Durante investigação observou-se alargamento mediastinal sem comprometimento pulmonar. Um tumor mediastinal medioposterior, medindo 14,8 × 10,8 × 8,4 cm, foi diagnosticado após tomografia computadorizada e biópsia videotoracoscópica. A imuno-histoquímica revelou timoma misto AB1. Devido à íntima relação com estruturas nobres e grandes proporções, optou-se pela quimioterapia.

Bocio del mediastino posterior - abordaje mínimamente invasivo: videotoracoscopia derecha más cervicotomía / Intrathoracic goiter resection by combined surgical approach: resection by right videothoracoscopy and cervicotomy

Resumen La cirugía es el manejo recomendado para el bocio intratorácico y cerca de un 90 % de ellos pueden resecarse mediante cervicotomía. El bocio en el mediastino posterior ha sido manejado satisfactoriamente empleando diversos abordajes cervicotorácicos, existiendo poca información en la literatura acerca del uso de la videotoracoscopia como parte de estas técnicas combinadas. Presentamos el caso de un paciente con un bocio intratorácico con extensión a mediastino posterior, en quien, dadas las características de la masa y su localización, sumado a las ventajas ampliamente conocidas de la cirugía mínimamente invasiva, se decide remplazar la toracotomía y la esternotomía por la videotoracoscopia, permitiendo una buena exposición y disección segura del mediastino. Consideramos que la videotoracoscopia es una técnica segura y efectiva en casos seleccionados de pacientes con bocio con extensión a mediastino posterior.

Abstract Surgery is the recommended treatment for intrathoracic goiter. About 90 % of the lessons can be resected by cervicotomy. The posterior mediastinal goiter was been successfully managed using different cervico-thoracic approaches; however, there is little available information in the literature about the use of videothoracoscopy as part of these combined techniques. We present a case of a patient with a intrathoracic goiter extended to the posterior mediastinum, in which, given the characteristics of the mass and its location added to the widely known benefits of minimally invasive surgery, it was decided to replace thoracotomy and sternotomy with videothoracoscopy allowing good exposure and safe dissection of the mediastinum. We consider that videothoracoscopy is a safe and effective technique in selected cases of patients with goiter extending into the posterior mediastinum.

A Case of Ruptured Thoracic Aortic Aneurysm Requiring Two-Stage Sternal Closure due to Posterior Mediastinal Hematoma / 日本心臓血管外科学会雑誌

A 70-year-old man with severe chest pain was transferred to our hospital by ambulance. Computed tomography revealed a ruptured thoracic aortic aneurysm and massive bleeding into the posterior mediastinum. Emergency total aortic arch replacement was performed through median sternotomy. However sternal closure induced severe hypotension because the heart was elevated anteriorly by the posterior mediastinal hematoma. The hematoma could not be eliminated fully so the sternum was kept open at the first operation followed by delayed sternal closure 3 days after the operation. After that, the postoperative course was uneventful and the patient was discharged on postoperative day 43.

A Case of Functioning Paraganglioma in Posterior Mediastinum / 대한내분비학회지

Paraganglioma is an extraadrenal pheochromocytoma originating from chromaffin cells distributed in the sympathetic nervous systems. Functioning extraadrenal paragangliomas represent more than 10% of all pheochromocytomas, and seems to be highly malignant tumor in comparison to intraadrenal pheochromocytomas. Recently, we experienced a case of a paraganglioma in the posterior mediastinum. A 32-year-old woman was admitted to hospital due to dyspnea on exertion, and intractable hypertension. A chest X-ray showed a well-defined mass density on the right cardiac border, and biochemical studies showed characteristic findings of pheochromocytoma. A solitary pheochromocytoma was located in the posterior mediastinum using 131I-MIBG scintigraphy. The clinical manifestations, including hypertension and dyspnea were improved after operation.

A Case of Nonfunctioning Paraganglioma of the Posterior Mediastinum / 영남의대학술지

Paraganglioma is a tumor from the extra adrenal paraganglion system and is rarely observed in the mediastinum. The authors experienced a case of nonfunctioning paraganglioma of the posterior mediastinum. The patient was 34-years-old male in whom abnormal mass lesion was nites in chest radiograph with hemoptysis. His blood pressure and serologic examination were within normal range upon admission to our hospital. Chest CT revealed a tumor in the left lower lobe. Diagnostic thoracoscopy was performed and diagnosed a posterior mediastinal mass. Surgical resection was them performed. Posterior mediastinal mass was removed successfully and histological examination of the surgical specimen diagnosed paraganglioma. He received radiotherapy after surgery and was followed up. Related literature are reviewed.

A Case of Primary Mediastinal Embryonal Carcinoma Arising in the Posterior Mediastinum / 결핵

Primary germ cell tumors of the mediastinum are rare, accounting 1-5% among all germ cell tumors and 10% of all neoplasms in this area. Approximately 85% of these tumors occur in men with a mean age 29 years. These tumors are mainly found in the anterior mediastinum and appear grossly as large lobulated masses. They are frequently invasive at the time of diagnosis and almost 90% of patients are symptomatic. Primary nonseminomatous germ cell tumor arising in the posterior mediastinum is very rare. We report a case of 37- year old male arising from the posterior mediastinum. Serum tumors markers including alpha-fetoprotein and beta-hCG which are usually elevated in germ cell tumor were not elevated. He was found to have a primary mediastinal embryonal carcinoma with pulmonary metastasis at open exploration. He was treated with debulking surgery and cisplatin-based chemotherapy, died of sepsis after 15 months postoperatively.

A Case of Foreign Body Granuloma of the Posterior Mediastinum / 결핵

21-year-old male was admitted for evaluation of a mass shadow on chest film. On chest computed tomography showed 5 cm sized homogeneous low density based on the second thoracic vertebral body in the posterior mediastinum. The patient had been performed thoracic sympathectomy 6 months before admission and oxidized cellulose was used for hemostasis at that operation Surgical resection was performed and microscopic result was foreign body granuloma caused by oxidized cellulose. Oxidized cellulose is an absorbable sterile mesh and used to control capillary or venous bleeding. Although the manufacturer recommends its removal after hemostasis is achieved, in clinical practice it is usually left in situ to reabsorb spontaneously, usually with no untoward effect.

Mediastinal Hemangioma: Report of a case

Benign hemangioma of the mediastinum is rare. This slowly growing tumor is described as well circumscribed, cystic, hemorrhagic tumor. Histologically it can be differentiated into capillary or cavernous form. We present a case of mediastinal hemangioma. A 20-year-old-man was presented with a slowly growing posterior mediastinal mass of 6 years duration, 8x6 cm in size. The mass was relatively well defined but focally invasive. Microscopically, it was differentiated into vessels of capillary, cavernous, and venous patterns. A solid cellular proliferation with inconspicuous capillary lumens was focally seen. The stroma between variable-sized vessels showed marked myxoid change associated with some smooth muscle bundles and adipose tissue. Ultrastructurally, areas of solid cellular proliferation showed formation of lumens. These lumens were lined by active endothelial cells showing plasmalemmal vesicles and Weibel-Palade bodies on the abluminal surface.

A Case of Hypertension Secondary to Paraganglioma of the Posterior Mediastinum

Functional paraganglioma of the mediastinum is an uncommon tumor of the paraganglion system that causes symptoms and signs of episodic catecholamine release. It has not been reported in Korea. We experienced a case of a 17 years old man with a history of diaphoresis and paroxysmal hypertension refractory to therapy since 14 years old. Urinary execretion of catecholamine and its metabolites were elevated. Computed tomography(CT) scan revealed high density mass located on the posterior mediastinum in the area of the right fifth intercostal space. At thoracotomy, a 3X3X4cm sized lesion was resected and confirmed as a paraganglioma.

A Case of Hypertension Secondary to Paraganglioma of the Posterior Mediastinum

The familial form in primary pulmonary hypertension is inherited as an autosomal dominant trait and is associated with a pattern of "genetic anticipation", a worsening of disease in subsequent generation, manifestated by greater severity or earlier onset. Familial primary pulmonary hypertension acounted for 6 percent of the 187 cases in the NIH registry. But, there is no reported case on Korea. We report on 25 years old woman who had PPH presenting with exertional dyspnea and dry coughing during second baby pregnancy and whose brother dies of PPH in other Hospital. Her simple chest X ray, 2-D Echocardiography, pulmonary angiogram and cardiac catheterization findings were compatible with typical primary pulmonary hypertension. Pulmonary function test was normal and perfuion lung scan had no evidence of pulmonary thromboembolism. There was no evidence of connective tissue diseases including SLE, RA, polymyositis and dermatomyositis and so on in the laboratory findings. Her younger brother had been admitted to other hospital due to aggravation of dyspnea, progressing slowly for 3 years and his case diagnosed as PPH through echocardiography, cardiac catheterrization, open lung biopsy and so on.