Staged surgical management of follicular thyroid carcinoma with extensive thrombus reaching up to right atrium - A case report.

INTRODUCTION: Differentiated thyroid carcinoma with an extensive intravenous tumor thrombus which is extending into internal jugular vein (IJV), superior vena cava (SVC) and right atrium (RA) is a rare clinical finding. We report a multimodal staged surgical approach for this life threatening complicated case. PRESENTATION OF CASE: A 52 year old female, presented with diffuse thyroid swelling, FNAC revealed it as follicular thyroid neoplasm. Computed tomography (CT) scan showed tumor thrombus extending into IJV, SVC and right atrium (RA). We planned complete resection of tumor in two stage operation. Initially in first stage, cardio-thoracic surgery was done to remove SVC and RA thrombus to eliminate the immediate risk of pulmonary embolism. In the second stage, neck surgery was performed to resect thyroid tumor and to perform extensive thrombectomy in the cervical veins. This patient has been followed for one year after successful surgery without recurrence. DISCUSSION: Venous involvement by follicular thyroid carcinoma reaching to RA is a rare life threatening condition. Though there is no standard guidelines available, treatment strategies should be discussed and planned among multidisciplinary team. Intraluminal extension is not a contraindication for aggressive surgical management. It will avoid fatal pulmonary embolism, as well as improve overall survival of the patient. CONCLUSION: Invasion of the great vessels by thyroid carcinoma is usually associated with early relapse and poor prognosis, but if tumor in the blood vessel is resected completely, a better prognosis is possible. Two staged surgical approach is safe and gives a predictable outcome.

Variant anatomy of internal jugular vein branching.

The knowledge of both normal and abnormal anatomy of the veins of the neck is important for clinicians performing catheterization and surgeons operating in the region of the neck. The presence of such anomalous communications may also be important for radiologists performing angiographic and sonographic studies. This study presents three cases of variant anatomy in posterior branching and abnormal branching of internal jugular vein found during our routine neck dissection.

Ultrasound guided drainage of submasseteric space abscesses.

BACKGROUND AND OBJECTIVES: The objective of this study was to evaluate the usefulness of ultrasound guided surgical drainage in submasseteric space abscess of odontogenic origin without incision. MATERIALS AND METHODS: Eleven patients (4 males and 7 females) aged 18 to 36 years were included in this study. Each patient had clinically and radiologically diagnosed submasseteric space abscesses of odontogenic origin. All the patients underwent ultrasound guided drainage by using 5.7 MHz B-mode, gray scale, ultrasound scanner. The aspirated pus was sent for microbiological culture and sensitivity tests. All the patients were given a prescription of antibiotics like Amoxicillin with Clavulanate in a dose of 625 mg 8 hourly daily, Metronidazole 400 mg 8 h daily and analgesic Diclofenac potassium in a dose of 50 mg 8 h daily. Infection was considered resolving when the following criteria were met like ceased or minimal drainage. RESULTS: There was successful resolution of abscess in 10 cases, 1 case underwent incision and drainage because of spread of infection to other spaces. CONCLUSION: This study on 11 cases supported ultrasonography as an intraoperative aid in the assessment of the abscess cavity and its real-time imaging facility will help in the location and drainage of the abscess cavity effectively. It avoids large, unsightly, postoperative facial scars and often eliminates the need of general anesthesia and hospitalization.