Catheter-guided percutaneous heartworm removal using a nitinol basket in dogs with caval syndrome

Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs. Several non-surgical and interventional methods are currently used for mechanical worm removal. However, the success rate and complications related to these methods are heavily dependent on methodology and retrieval devices used. In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure. With this technique, we successfully treated four dogs with caval syndrome.

Percutaneous heartworm removal from dogs with severe heart worm (Dirofilaria immitis) infestation

Canine heart worm disease is often life-threatening due to its various complications, including right side heart failure, caval syndrome and pulmonary eosinophilic granulomatosis. Several preventive medications and melarsomine have been developed and they are very effective to control heartworm infestation. However, in a case of severe infestation, melarsomine therapy often results in an unfavorable outcome because of the severe immune reaction caused by rapid killing of the adult worm. Surgical removal and an interventional method using flexible alligator forceps have been well described in the literature. Despite the usefulness of mechanical removal using flexible alligator forceps, the methodology still needs to be upgraded for increasing the applicability for treating dogs with severe infestation. We describe herein a newly developed percutaneous removal method for heartworms and this was successfully applied to 4 dogs with severe heartworm infestation. The follow-up studies also showed favorable outcomes with no complications.

Localized Fibrosing Mediastinitis with Superior Vena Caval(SVC) Syndrome / 결핵및호흡기질환

Fibrosing mediastinitis is a rare disease that is characterized by the proliferation of dense fibrous tissue of the mediastinum. The pathogenesis of fibrosing mediastinitis is unknown in most cases. However, histoplasmosis, tuberculosis, autoimmune disease, radiation therapy, and other idiopathic fibroinflammatory diseases have been implicated in some cases. Most clinical features are related to an obstruction or compression of the mediastinal structure. Fibrosing mediastinitis is often progressive and occurs diffusely throughout the mediastinum. We encountered a case of fibrosing mediastinitis of a very focal lesion without evidence of mediastinal involvement. The condition was confirmed by biopsy and graft bypass surgery was performed because of SVC syndrome.

Superior Vena Caval Syndrome Due to Tuberculous Lymphadenitis / 결핵및호흡기질환

Superior vena cava syndrome(SVCS) is most often encountered in patients with malignancies. Tuberculosis is nowadays an uncommon cause of SVCS. We report the case of a patient who presented with respiratory symptoms accompanied by SVCS due to tuberculous lymphadenitis. Treatment was instituted with isoniazid, rifampicin, pyrazinamide and ethambutol, and all symptoms disappeared. To our knowledge, no case of SVCS provoked by tuberculous lymphadenitis has been described previously in Korea.

A Case of Anterior Mediastinal Mass Presenting with SVC Syndrome / 결핵

A 36-year-old man was studied because of signs and symptoms of superior vena naval syndrome. Chest computerized topography showed 10x8x6 cm sized lobulated anterior mediastinal mass, compressing superior vena casa. Fine needle aspiration cytology revealed seminoma. There was no detectable tumor mass in the testes. We report a case of primary mediastinal seminoma presenting with superior vena canal syndrome.

Postoperative Airway Obstruction in a Patient With Huge Mediastinal Hemangioam / 대한마취과학회지

Anesthesia for the patients with mediastinal mass may be associated with significant respiratory and cardiovaacular complications due to compression of traeheobronchial trees, the pulmonary artery, heart and superior vena cava The authors present a case of a 6-year-old girl with a large mediastinal tumor located in anterior and superior mediaetinum. Preoperatively, the patient was asymptomatic and anesthesia was induced and maintained uneventfully. Operative finding was that 8 X 14 cm sized hemangioma was extended superiorly over thoracic outlet, posteriorly aorta and SVC, medially pericardium and right hilum and inferiorly right upper lung and pleura. Because difficulties in removal of the hemangioma were expected, exploratory thoracotomy was discontinued. On emergence, as soon as the patient was extubated due to irritability, the patient became cyanotic and was noticed bulging mass on right supraclavicular area, Intubation was attempted and during direct laryngoscopy, anesthesiologist also noticed a bulging mass in right oral cavity. Postoperatively, the patients airway was kept with endotracheal tube, but cyanosis appeared on the face and skin over the chest, but not below the abdomen. Bulging mass on right supraclavicular area, distension of neck vein and conjunctival edema were noticed only when the patient was crying or suctioned. Symptoms improved by deep sedation. We assumed that enlargement of hemangioma due to increased central blood volume occasionally compressed tracheobronchial tree and sup. vena cava when patient was irritable, crying and coughing. On 11th postoperative day, patient was transferred to the another hospital for the better treatment with endotracheal intubation.