Renal angiomyolipoma with inferior vena cava and right atrial embolism: A case report and literature review / 中南大学学报(医学版)

Renal angiomyolipoma (AML) with renal vein, inferior vena cava (IVC), and right atrial embolism is a rare solid tumor, whose etiology and pathogenesis are still unclear. Moreover, it is often misdiagnosed. One patient with renal AML complicated with renal vein, IVC, and right atrial embolism was admitted to the Second Xiangya Hospital of Central South University, who was a 35-year-old female, without any previous medical history, presented with right low back pain for more than 3 years. Computed tomography (CT) scan showed irregular lobulated fatty density mass in the right kidney, renal vein, IVC, and right atrium. The contrast-enhanced scan showed no enhancement of fat components at each phase and mild enhancement of solid components. Radical resection of the right kidney and removal of tumor thrombus were performed, and there was no recurrence 1 year after the operation. It is rare for renal AML to grow along the renal vein, IVC, and extend to the right atrium. Imaging examination is extremely important, and the CT findings of this case are characteristic, but the diagnosis eventually depends on pathological and immunohistochemical examinations.

Tratamiento multidisciplinar del leimiosarcoma de vena cava inferior / Multidisciplinary treatment of leiomyosarcoma of inferior cava

Resumen Introducción Los leiomiosarcomas de la vena cava inferior son tumores raros, sólo hay 300 casos descritos en la literatura. Su incidencia es mayor en mujeres, suelen aparecer entre los 50-60 años, y presentan una progresión lenta y mal pronóstico. Los síntomas son inespecíficos haciendo que el diagnóstico se realice de forma tardía, éste se realiza mediante pruebas de imagen y biopsia guiada. Caso clínico Se presenta el caso de un varón de 73 años con diagnóstico de leiomiosarcoma de la vena cava inferior, como hallazgo incidental en TC de control, tratado mediante radioterapia neoadyuvante, cirugía y radioterapia intraoperatoria. Discusión El único tratamiento que ha descrito modificaciones en la supervivencia es la cirugía. El papel de la adyuvancia y neoadyuvancia en estos tumores es muy controvertido. La elección de la actitud terapéutica dependerá de la localización del tumor, tamaño, la relación con estructuras adyacentes y la presencia de circulación colateral.

Introduction Leiomyosarcomas of the inferior vena cava are rare tumors, with fewer than 300 cases reported. Its incidence is higher in females, usually appear in the sixth decade and they have a slow-growing and poor prognosis. Symptoms are generally non-specific. Diagnosis is made with imaging studies and guided biopsy. Clinical Case We report a case of a 73-year-old male patient with leimyosarcoma of the inferior vena cava treated by neoadjuvant radiotherapy, surgery and intraoperative radiotherapy. Discussion Surgery is the only treatment that can improve the survival. The role of the adjuvancy and neoadjuvancy is very controversial. Surgical management is determined by the location of the tumour, the relationship with adjacent structures and the presence of collateral veins.

Diagnostic accuracy of contrast-enhanced ultrasound for detecting bland thrombus from inferior vena cava tumor thrombus in patients with renal cell carcinoma

ABSTRACT Purpose: To evaluate the role of contrast-enhanced ultrasound (CEUS) in differentiating bland thrombus from tumor thrombus of the inferior vena cava (IVC) in patients with renal cell carcinoma (RCC). Materials and Methods: We retrospectively investigated 30 consecutive patients who underwent robot-assisted radical nephrectomy with IVC thrombectomy and had pathologically confirmed RCC. All patients underwent US and CEUS examination. Two off-line readers observed and recorded thrombus imaging information and enhancement patterns. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value for bland thrombus were assessed. Results: Of the 30 patients, no adverse events occurred during administration of the contrast agent. Early enhancement of the mass within the IVC lumen on CEUS was an indicator of tumor thrombus. Bland thrombus showed no intraluminal flow on CEUS. There were eight (26.7%) patients with bland thrombus, including three level II, two level III, and three level IV. There were three cases with cephalic bland thrombus and five cases with caudal bland thrombus. Three caudal bland thrombi extended to the iliac vein and underwent surgical IVC interruption. Based on no intraluminal flow, for bland thrombus, CEUS had 87.5% sensitivity, 100% specificity, 96.7% accuracy, 100% positive predictive value and 95.6% negative predictive value. Conclusion: Our study demonstrates the potential of CEUS in the differentiation of bland and tumor thrombus of the IVC in patients with RCC. Since CEUS is an effective, inexpensive, and non-invasive method, it could be a reliable tool in the evaluation of IVC thrombus in patients with RCC.

Robotic excision of complex adrenal mass with retrocaval extension and encasement of renal hilum with renal preservation

ABSTRACT Objective: The purpose of this video is to present robotic excision of a complex adrenal mass with retrocaval extension and encasement of renal hilum in a 16 year old boy. Biochemical screening was negative for metabolically active component. Computerized tomographic scan with contrast revealed a homogenous mass of approximately 10.8 cm x 6.2 cm x 4.2 cm in the suprarenal area on right side that was extend-ing behind inferior vena cava and encasing renal hilar vessels. Imaging findings were that of a classical ganglioneuroma. Material and methods: Robot assisted laparoscopic adrenalectomy with sparing of renal hilar vasculature was performed. With patient in lateral position, five ports were used, including one for liver retraction. Da Vinci® system with four arms was docked from over the right shoulder. The displaced renal hilar structures were identified by opening Gerota's fascia. Mass was dissected completely and removed through Pfan-nensteil incision. Results: Duration of procedure was 345 minutes and console time was 290 minutes. Blood loss was 250 mL. Post-operative renal doppler showed normal blood flow. He was discharged on post-operative day three. Histopathologic examination of specimen revealed ganglioneuroma arising from adrenal gland. Conclusion: Ganglioneuroma is a rare adrenal tumor with good prognosis on surgical removal. The advent of robotic surgery has made complex surgical procedures involving vital structures like inferior vena cava be performed using minimally invasive techniques without compromising oncologic principles.

Pure Yolk sac presenting with inferior vena cava thrombus extending from bilateral external iliac veins to hepatic vein

ABSTRACT Introduction: Vena cava thrombus is an extremely rare complication of testicular tumors. We report on an unusual case of testicular tumor presenting with inferior vena cava thrombus extending from the left spermatic and bilateral external iliac veins to the hepatic vein. Case report: A-35-year old man presented with a 6-month history of left scrotal mass and a 1-day history of bilateral lower extremity edema. Computed tomography (CT) revealed the presence of thrombus extending from the left spermatic vein and bilateral external iliac veins to the hepatic vein, and multiple lymph node and lung metastases. 3 cycles of chemotherapy were given after the left high inguinal orchiectomy. Pathological examination demonstrated a pure yolk sac carcinoma with lymphovascular invasion and direct tumor extension into the left spermatic cord. CT and positron emission tompgraphy-CT obtained no findings of metastasis or recurrence at 3 months after the chemotherapy. Conclusion: We review this seldom case and discuss the literature with regard to its diagnosis and treatment.

Rare Complication of non-Treated Abdominal Aortic Aneurysm: Extensive Thrombus in Right Cardiac Chambers / Complicação Rara de Aneurisma da Aorta Abdominal não Tratado: Trombo Extenso em Câmaras Cardíacas Direitas

Abstract A 78-year-old patient presented with shortness of breath after falling down. Transthoracic echocardiogram showed an extensive thrombus in the right atrium (RA), extensive thrombosis of the inferior vena cava (IVC), and abdominal aortic aneurysm (AAA). A magnetic resonance confirmed the thrombosis of the RA extending to the IVC, which was apparently fused to the abdominal aortic aneurysm (compression? erosion?). This case illustrates a severe and rare complication of a non-treated AAA. There probably was IVC erosion by the aortic aneurysm, leading to blood stasis and extensive thrombosis of the IVC and right cardiac chambers.

Resumo Uma paciente de 78 anos procurou o serviço de emergência apresentando dispneia após sofrer queda da própria altura. O ecocardiograma transtorácico mostrou um extenso trombo no átrio direito (AD), trombose extensa da veia cava inferior (VCI), e aneurisma de aorta abdominal (AAA). A ressonância magnética confirmou a trombose do AD estendendo-se até a VCI, a qual aparentemente apresentava fusão ao aneurisma da aorta abdominal (compressão? erosão?). Este caso ilustra uma complicação grave e rara de um AAA não tratado. Provavelmente houve uma erosão da VCI pelo aneurisma da aorta resultando em estase sanguínea e trombose extensa da veia cava inferior e cavidades cardíacas direitas.

Flúter auricular en paciente con isomerismo izquierdo yvena cava inferior izquierda interrumpida / Atrial flutter in a patient with left isomerism and left-sided inferior venacava interruption

Se comunica la ablación de un flúter auricular con una longitud de ciclo de 260 ms en un paciente de 28 años con isomerismoizquierdo y vena cava inferior izquierda interrumpida. Mediante encarrilamiento, demostramos la participación del istmo suprahepáticotricuspídeoen el circuito de macroreentrada. Realizamos líneas de ablación con radiofrecuencia que detuvieron la arritmia primaria yculminó en ritmo de escape noda.

We report the ablation of an atrial flutter with a 260 ms cycle length in a 28-year-old patient with left isomerism and interrupted leftinferior vena cava. We showed the participation of the suprahepatic – tricuspid isthmus in the macro reentry circuit by the entrainmentmaneuver.

Tumores que invaden la vena cava inferior: revisión pictográfica de los principales hallazgos imagenológicos en tomografía computarizada y resonancia magnética / Tumours that invade the inferior vena cava: an illustrative review of the main imaging features on computed tomography and magnetic resonance

Abstract. The objective of this article is to describe the multiple entities that can affect and invade the inferior vena cava. These can be either benign entities, but with an aggressive behaviour, or malignancies that originate in the organs adjacent to this vascular structure, or in itself as a leiomyosarcoma. The present review shows different examples in Computed Tomography and Magnetic Resonance, with cases of angiomyolipoma, phaeochromocytoma, adrenal cortical carcinoma, renal cell carcinoma, hepatocellular carcinoma, a retroperitoneal sarcoma and a leiomyosarcoma originating in the inferior vena cava. Besides these, there are situations that may lead to diagnostic errors, such as the flow artefacts and pseudolipoma.

El objetivo de este artículo es describir las múltiples entidades que pueden afectar e invadir la vena cava inferior. Entre ellas podemos enumerar tanto entidades benignas, pero con un comportamiento agresivo, como procesos malignos que se originan en órganos adyacentes a esta estructura vascular o en ella misma como el leiomiosarcoma. En la presente revisión se exponen diferentes ejemplos en tomografía computarizada y resonancia magnética con casos de angiomiolipoma, feocromocitoma, carcinoma suprarrenal, carcinoma de células renales, hepatocarcinoma, sarcoma retroperitoneal y leiomiosarcoma originado en la vena cava inferior. Además se exponen situaciones que pueden inducir a errores diagnósticos como los artefactos de flujo y el pseudolipoma.

Uterine Intravenous Leiomyomatosis with Intracardiac Extension and Pulmonary Benign Metastases on FDG PET/CT: A Case Report

A 48-year-old woman presented with a 50-day history of irregular vaginal bleeding and lower abdominal pain. Ultrasound indicated an extremely large occupying lesion in the pelvic cavity that was highly suggestive of malignancy. Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed to further assess the nature of pelvic abnormality. PET/CT images demonstrated a diffusely lobulated mass ranging from cervix up to the inferior pole of kidneys with mild FDG uptake. Simultaneously, multiple nodules in bilateral lungs and a hypodense lesion in the right ventricle were shown without FDG-avidity. Based on the imaging results, the presumptive diagnosis was uterine intravenous leiomyomatosis with intracardiac extension and pulmonary benign metastases, which was subsequently confirmed by MRI and the lesion biopsy.

Trombosis de vena cava inferior y endocarditis en un paciente prematuro: Caso clínico / Inferior vena cava thrombosis and endocarditis in a premature patient: Case report

Thrombosis of the inferior vena cava represents a significant percentage of all venous thrombosis that take place during the neonatal period, generally associated with risk factors such as the use of central venous catheter. The incidence of bacterial endocarditis in preterm infants is low. Objectives: To characterize the case of a preterm neonate with both conditions and to detail the disease changing spectrum in the neonatal population and its therapeutic possibilities. Case report: Premature newborn, 31 + 5 weeks of gestation who presented Enterococcus faecalis bacteremia, developed progressive thrombosis of the inferior vena cava and right atrium secondary to the use of umbilical venous catheter, with subsequent diagnosis of endocarditis. He was treated with anticoagulation with subcutaneous low molecular weight heparin. Given a favorable evolution, it was decided to continue the anticoagulation therapy for 4-6 weeks, and at the time of discharge, aspirin treatment was given. Conclusions: The preterm infant with infective endocarditis and intracardiac thrombus presents an interesting management dilemma. Treatment should be individualized according to the clinical evolution and safety profile of thrombolytic and/or anticoagulant agents. Availability and advantages of low molecular weight heparin have led to its use as an alternative treatment in neonates and infants with deep venous thrombosis.

La trombosis de la vena cava inferior corresponde a un porcentaje importante de las trombosis venosas en la etapa neonatal, generalmente asociado a factores de riesgo como el uso de catéter venoso central. La incidencia de endocarditis bacteriana en recién nacidos prematuros es baja. Objetivos: Caracterizar el caso de un neonato pretérmino en que se asociaron ambas patologías y detallar el espectro cambiante de esta enfermedad en la población neonatal y sus posibilidades terapéuticas. Caso clínico: Recién nacido prematuro de 31 + 5 semanas de gestación, que presentó bacteriemia por Enterococo faecalis, evolucionó con trombosis progresiva de la vena cava inferior y aurícula derecha secundaria al uso de catéter venoso umbilical, con posterior diagnóstico de endocarditis. Se manejó con anticoagulación con heparina de bajo peso molecular en forma subcutánea, dada evolución favorable, se decidió continuar manejo médico con terapia anticoagulante por 4-6 semanas, y al alta manejo con aspirina. Conclusiones: El neonato pretérmino con endocarditis infecciosa y trombo intracardiaco presentan un dilema interesante de manejo, por lo cual se debe individualizar el tratamiento según la evolución clínica y el perfil de seguridad de los agentes trombolíticos y/o anticoagulantes. La disponibilidad y las ventajas de la heparina de bajo peso molecular ha dado lugar a su uso como una alternativa de tratamiento en neonatos y niños con trombosis venosa profunda.

Inferior venacaval compression due to excessive abdominal packing / Compressão da veia cava inferior por causa do excesso de tamponamento abdominal / Comprensión de la vena cava inferior debido al exceso de taponamiento abdominal

Inferior venacaval compression is a common problem in late pregnancy. It can also occur due to compression of inferior venacava by abdominal or pelvic tumors. We report a case of acute iatrogenic inferior venacaval compression due to excessive abdominal packing during an intraabdominal surgery.

Compressão da veia cava inferior é um problema comum no fim da gravidez. Também pode ocorrer por causa da compressão da veia cava inferior por tumores abdominais ou pélvicos. Relatamos um caso de compressão iatrogênica aguda da veia cava inferior por causa do excesso de tamponamento durante uma cirurgia intra-abdominal.

La compresión de la vena cava inferior es un problema común al final del embarazo. También puede ocurrir debido a la compresión de la vena cava inferior por tumores abdominales o pélvicos. Relatamos un caso de compresión iatrogénica aguda de la vena cava inferior debido al exceso de taponamiento durante una cirugía intraabdominal.

CT Findings of Intrarenal Yolk Sac Tumor with Tumor Thrombus Extending into the Inferior Vena Cava: A Case Report

Yolk sac tumor (YST) is a rare germ cell neoplasm of childhood that usually arises from the testis or ovary. The rare cases of YST in various extragonadal locations have been reported, but the primary intrarenal YST is even more uncommon. Here, we report a case of a primary intrarenal YST with tumor thrombus of the inferior vena cava and left renal vein in a 2-year-old boy, with an emphasis on the CT features. To our knowledge, this is the first reported case of an intrarenal YST with intravascular involvement.

Isolated dilatation of the inferior vena cava

The diameter and collapsibility of the inferior vena cava (IVC) should be interpreted in consideration with other clinical and echocardiographic parameters before drawing definitive diagnostic conclusions. We report a case of a 46-year-old female with isolated IVC dilation and diminished inspiratory collapse without other abnormalities, and provide a brief review of the literature.

Leiomiomatose endovenosa: abordagem anestésica a propósito de um caso clínico / Anesthetic approach for a clinical case of intravenous leiomyomatosis: case report / Leiomiomatosis endovenosa: abordaje anestésico a propósito de un caso clínico

JUSTIFICATIVA E OBJETIVOS: Descrevemos a abordagem anestésica a propósito de um caso clínico de leiomiomatose endovenosa, com invasão da veia cava inferior e extensão à aurícula direita, tratada com êxito por meio de abordagem cirúrgica. RELATO DE CASO: Doente do sexo feminino, 45 anos, aparentemente estável até duas semanas antes da ida à urgência, altura em que iniciou cansaço e dispneia. Fez ecocardiograma, no qual se constatou massa intracardíaca. Por isso, fez tumorectomia eletiva na transição veia cava-aurícula direita e ventrículo direito. À histologia, a peça operatória evidenciou sugestividade de leiomioma uterino. Posteriormente, para avaliar a extensão, fez-se tomografia computadorizada, que demonstrou extensão à veia cava inferior e ao ovário esquerdo. Foi então proposta para histerectomia total, anexetomia esquerda e salpingectomia direita, remoção de leiomioma intravenoso e colocação de filtro definitivo na veia cava inferior. Neste artigo descreve-se a abordagem anestésica com particular ênfase na correção das necessidades hídricas, bem como na evolução no pós-operatório, e salientam-se possíveis contributos à abordagem futura de casos semelhantes. CONCLUSÕES: O diagnóstico pré-operatório de leiomiomatose endovenosa é extremamente difícil. O tratamento consiste na extração cirúrgica. Esse procedimento envolve importantes perdas hemáticas e, por isso, condicionou a preparação pré-operatória. No intraoperatório a fluidoterapia foi fulcral e a monitoração invasiva se assumiu como preponderante no auxílio do equilíbrio hidroeletrolítico da doente. A existência de um laboratório de análises clínicas acessível e com resposta rápida e avaliação gasimétrica próxima foi determinante. A unidade de cuidados intensivos equipada com ventilador para os cuidados pós-operatórios revelou-se outra necessidade decorrente deste caso.

BACKGROUND AND OBJECTIVES: The aim of this study was to describe the anesthetic approach in a case of intravenous leiomyomatosis with invasion of the inferior vena cava and extension to the right atrium, successfully treated with surgical approach. CASE REPORT:Female patient, 45 years old, apparently stable until two weeks before the admission to the emergency department with complaints of fatigue and dyspnea. Echocardiogram was performed, which detected an intracardiac mass. Therefore, elective tumorectomy was performed in the vena cava-right atrium and right ventricle transition. Histological examination of the specimen suggested uterine leiomyoma. Subsequently, to assess the extent, computed tomography was done and showed extension to the inferior vena cava and left ovary. Hysterectomy, left adnexectomy and right salpingectomy, removal of intravenous leiomyoma, and permanent filter placement in the inferior vena cava were proposed. In this article, we describe the anesthetic approach with particular emphasis on the correction of fluid requirements, as well as postoperative evolution, and we highlight possible contributions to future approach of similar cases. CONCLUSIONS: Preoperative diagnosis of intravenous leiomyomatosis is extremely difficult. Treatment consists of surgical removal. This procedure involves major blood loss and, therefore, preoperative preparation was conditioned: intraoperative fluid therapy was central and invasive monitoring considered predominant to assist in fluid and electrolyte balance of the patient; the existence of a clinical laboratory accessible and with rapid response and blood gas assessment was crucial; the intensive care unit equipped with ventilator for postoperative care proved to be another requirement resulting from this case.

JUSTIFICATIVA Y OBJETIVOS: Describimos aquí el abordaje anestésico a propósito de un caso clínico de leiomiomatosis endovenosa, con invasión de la vena cava inferior y extensión a la aurícula derecha, que tuvo éxito por medio de un abordaje quirúrgico. RELATO DE CASO: Mujer enferma, de 45 años, aparentemente estable hasta dos semanas antes de su llegada a urgencias, en que debutó con cansancio y disnea. Hizo el ecocardiograma en que se comprobó masa intracardiaca. Por eso, se procedió a la tumorectomía electiva en la transición vena cava-aurícula derecha y ventrículo derecho. En la histología, la pieza operatoria mostró una sugestión de leiomioma uterino. Posteriormente, para evaluar la extensión, se realizó la tomografía computadorizada, que arrojó una extensión a la vena cava inferior y al ovario izquierdo. Entonces se propuso la histerectomía total, anexetomía izquierda y salpingectomía derecha, retirada de leiomioma intravenoso y colocación de filtro definitivo en la vena cava inferior. En este artículo, describimos el abordaje anestésico dándole un énfasis particular a la corrección de las necesidades hídricas, como también a la evolución en el posoperatorio, destacando posibles aportes al abordaje futuro de casos parecidos. CONCLUSIONES: El diagnóstico preoperatorio de leiomiomatosis endovenosa es extremadamente difícil. El tratamiento consiste en la extracción quirúrgica. Ese procedimiento involucra importantes pérdidas hemáticas y por eso, condicionó la preparación preoperatoria. En el intraoperatorio la fluidoterapia fue fundamental y la monitorización invasiva se asumió como preponderante en el auxilio del equilibrio hidroelectrolítico del enfermo. La existencia de un laboratorio de análisis clínicos accesible y con una respuesta rápida y una evaluación de la gasometría fue determinante. La unidad de cuidados intensivos equipada con ventilador para los cuidados postoperatorios fue otra necesidad originada por este caso.

Technology: An aid to clinical judgement.

Complete removal of renal cell tumor with thrombus which extends above the diaphragm often necessitates use of cardiopulmonary bypass. Transesophageal echocardiography (TEE) can play an important role in delineating the extent of tumor growth. We describe a patient with renal cell carcinoma with thrombosis invading into the right ventricle and its complete removal with the aid of TEE.

Leiomiomatosis intravenosa de origen pelviano con extensión intracardiaca: Reporte de dos casos / Pelvic intravenous leiomyomatosis with intracardiac extension: Report of two cases

Background: symptoms predominate. Diagnosis is based on clinical findings and appropriate imaging. We report two females, aged 35 and 51 years. One of them presented with a pelvic mass and dyspnea, the other patient had severe cardiac failure on admission. Computed axial tomography scan allowed an accurate preoperative diagnosis on both patients. Successful one stage resection of the tumor was performed under cardiopulmonary bypass. Both patients are asymptomatic on follow up at 6 months and 25 years.

Colapsibilidade da Veia Cava Inferior e sinais e sintomas de insuficiência cardíaca: novos insights e possíveis associações / Inferior Vena Cava collapsibility and heart failure signs and symptoms: new insights about possible links

FUNDAMENTO: Nos pacientes com Insuficiência Cardíaca Crônica (ICC) foram propostas medidas ultrassonográficas do Índice de Colapsibilidade da Veia Cava Inferior (ICVCI) para obter uma avaliação e classificação minuciosa da congestão hemodinâmica. OBJETIVO: A finalidade deste estudo era correlacionar os achados no exame físico com o ICVCI em pacientes com ICC. MÉTODOS: De acordo com um projeto de coorte retrospectivo, analisamos 54 pacientes com ICC, direita ou biventricular, classe NYHA III. O plano era determinar se alguma faixa de ICVCI basal poderia predizer uma persistência ou agravamento da congestão clínica achada no final do acompanhamento subsequente (isto é, após 1-2 meses do tratamento oral otimizado). Para essa finalidade, os pacientes foram subdivididos em três grupos de acordo com o valor de ICVCI basal: ≤ 15% (13 pts), 16 - 40% (21 pts) e > 40% (20 pts). Diversos critérios clínicos de congestão foram comparados por meio dos três grupos e incorporados subsequentemente ao modelo multivariado de Cox. RESULTADOS: Preditores multivariados de alto escore de congestão foram distensão da veia jugular (FC: 13,38 95% IC: 2,13 - 84 p = 0,0059) e estertores (FC: 11 95% C.I : 1,45 - 83,8 p = 0,0213). O ICVCI ≤ 15% esteve sempre associado com um alto escore de congestão na segunda visita; todavia, o ICVCI o ≤ 15% não predisse um alto escore de congestão na segunda visita. CONCLUSÃO: No âmbito da ICC, um baixo ICVCI não predisse, em forma confiável, um elevado escore de congestão. Não obstante, o conjunto com ICVCI ≤ 15% sempre se achou associado com sinais e sintomas de uma ICC descompensada, tanto do lado direito como do esquerdo. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: In chronic heart failure patients (CHF), ultrasound measurement of inferior vena cava collapsibility index (IVCCI) has been proposed to yield careful assessment and grading of the hemodynamic congestion. OBJECTIVE: The purpose of this study was to correlate the findings of physical examination with IVCCI in CHF patients. METHODS: According to a retrospective cohort design, we analyzed 54 CHF patients with right or biventricular CHF, belonging to III NYHA class. We planned to determine whether any basal IVCCI range would be able to predict persistent or worsening clinical congestion found at the end of subsequent follow up (i.e. after 1-2 months of oral optimized therapy). For this purpose, the patients were subdivided by three groups according to the basal IVCCI value: ≤ 15% (13 pts), 16 - 40% (21 pts) and > 40% (20 pts).Several clinical criteria of congestion were compared across the three groups and subsequently entered in the Cox multivariate model. RESULTS: Multivariate predictors of high congestion score were jugular venous distension (HR: 13,38 95% C.I.: 2,13 - 84 p = 0,0059) and rales (HR: 11 95% C.I : 1,45 - 83,8 p = 0,0213). IVCCI ≤ 15% was always associated with high congestion score at the second visit; but IVCCI ≤ 15% failed to predict high congestion score at the second visit. CONCLUSION: In CHF setting, low IVCCI did not reliably predict high congestion score. Nevertheless, the cluster with IVCCI ≤ 15% was always found associated with signs and symptoms from both right and left-sided decompensated CHF. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

Aggressive Angiomyxoma: an Unusual Presentation

Aggressive angiomyxoma is an uncommon mesenchymal myxoid tumor that is characterized by slow growth and frequent local recurrence. It is currently regarded as a nonmetastasizing tumor. We describe a case of recurrent aggressive angiomyxoma with invasion into the veins including the inferior vena cava and the right atrium and with pulmonary metastases. Our case, together with those unusual cases documented in previous reports, may lead to a reappraisal of the nature of aggressive angiomyxoma.

Sarcoma de vena cava inferior / Sarcoma of the vena cava inferior

Se presentó un caso infrecuente de una paciente con tumor abdominal y gran circulación colateral superficial tipo cava-cava, el ultrasonido abdominal, el ecocardiograma trans-torácico y transesofágico y la tomografía axial computarizada identificaron un tumor de la vena cava inferior. La citología aspirativa con aguja fina de la lesión confirmó que se trataba de un sarcoma fusopleomórfico de alto grado de malignidad primario de la vena cava inferior

Authors present an infrequent case of a female patient with abdominal tumor a great superficial collateral circulation type cava-cava, the abdominal ultrasound, the transthoracic and transesophageal echocardiogram and the computerized axial tomography (CAT) identified a tumor of the vena cava inferior. The fine-needle aspiration cytology of lesion confirmed the presence of primary fusopleomorphous sarcoma of high degree of malignancy of vena cava inferior