Adrenal Tumors with Venous Thrombosis: A Single-Institution Experience

Osman, Yasser; Haraz, Ahmed; El-Mekresh, Mohsen; Gomha, Abdul-Monem; El-Ghar, Mohamed Abou; Eraky, Ibrahim

doi:10.1159/000326942

Cited by 11 publications

(7 citation statements)

References 23 publications

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“…A review of 206 patients receiving unilateral adrenalectomy for adrenal tumors found a 2.9% incidence of associated thrombosis. 48 Unlike other visceral infarcts, the adrenal gland is prone to hemorrhage, a clinical sequela that precedes or results from the infarction. A risk of recurrent hemorrhage always exists if anticoagulation therapy is restarted, although the risk of thrombosis in patients with untreated hypercoagulable disorders must be weighed against the potential for recurrent hemorrhage.…”

Section: Adrenal Infarc Tionmentioning

confidence: 99%

“…Unilateral thrombosis is often secondary to primary or secondary adrenal malignancy. A review of 206 patients receiving unilateral adrenalectomy for adrenal tumors found a 2.9% incidence of associated thrombosis . Unlike other visceral infarcts, the adrenal gland is prone to hemorrhage, a clinical sequela that precedes or results from the infarction.…”

Section: Adrenal Infarctionmentioning

confidence: 99%

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Arterial thrombosis in unusual sites: A practical review

O’Donnell

Shatzel

Olson

et al. 2018

European J of Haematology

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While common forms of arterial disease such as stroke and myocardial infarction are well studied and appropriate treatment algorithms are well described, occasionally, practitioners will encounter patients with thrombosis in other arteries; the cause and treatment of which is not entirely obvious or well studied. In this section, we will review the current data on arterial thrombosis, describing anatomic sources and hypercoagulable associations, and outline the epidemiology, pathophysiology, clinical presentation, etiology, and treatment of intracardiac thrombus, primary aortic mural thrombus, visceral infarctions, and cryptogenic limb ischemia. (Table 1). | ARTERIAL THROMBOS IS-ANATOMIC CONS IDER ATIONSArterial thrombosis most often occurs in association with atherosclerosis. In cryptogenic cases, arterial thrombosis may result from an anatomic source, the most common of which is cardioembolic, such as intracardiac thrombus, atrial appendage thrombus, patent foramen ovale with paradoxical embolus, and valvular vegetation.The minimal workup we consider in truly cryptogenic cases is assessment for a cardioembolic source ( Figure 1) including a transthoracic echocardiogram in conjunction with injection of agitated saline contrast and color Doppler imaging in order to detect a patent foramen ovale. Due to the unique nature of intracardiac thrombi and primary aortic mural thrombi, the following sections will outline the epidemiology, etiology, and management of these entities. | INTR AC ARD IAC THROMB ILeft ventricular (LV) thrombus most commonly occur after myocar- K E Y W O R D Sarterial thrombosis, coagulation disorder, hypercoagulable, infarction

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Section: Adrenal Infarc Tionmentioning

confidence: 99%

Section: Adrenal Infarctionmentioning

confidence: 99%

Arterial thrombosis in unusual sites: A practical review

O’Donnell

Shatzel

Olson

et al. 2018

European J of Haematology

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“…Adrenocortical carcinoma is infrequently associated with venous tumour thrombus (2.9%) 1. Venous involvement occurs earlier in right-sided tumours due to the renal vein on the left side.…”

Section: Descriptionmentioning

confidence: 99%

Adrenocortical carcinoma with inferior vena cava tumour thrombus: multidetector CT (MDCT) evaluation and management

et al. 2015

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DESCRIPTIONA 58-year-old man, a farmer, who was a known hypertensive poorly controlled on metoprolol, amlodipine and enalapril, presented with sweating and giddiness for 10 months and pedal oedema for 3 months. On ultrasonography, a heteroechoic mass was found near the upper pole of his left kidney. Multidetector CT of the abdomen showed an 11×8×5 cm heterogeneous mass arising from the left adrenal gland, with an attenuation of 28 HU on non-contrast CT and 35% absolute washout on delayed film. The venous thrombus extended from left adrenal vein into the infradiaphragmatic inferior vena cava (IVC), extending 2.5 cm above the hepatic vein confluence (figures 1 and 2). Urinary normetanephrines were 889 mg/24 h, urinary metanephrine was 107 mg/24 h and serum cortisol level was 800 nmol/L. The patient underwent left open adrenalectomy with IVC thrombectomy. At 2-year follow-up, he was normotensive without any signs of residual/recurrent disease.Adrenocortical carcinoma is infrequently associated with venous tumour thrombus (2.9%). 1Venous involvement occurs earlier in right-sided tumours due to the renal vein on the left side. CT washout studies are the gold standard for differentiating adenoma from carcinoma, the former suggested by absolute percentage washout >60% or relative percentage washout >40%. Hypersecretion of adrenal hormones is found in 50-80% of patients, the most common being cortisol. Catecholamines are typically normal, although false elevation is seen with use of β-blockers to control hypertension. 2With IVC tumour thrombus, survival is 25% at 5 years in absence of metastatic disease and only 20% at 2 years in presence of metastasis. 3Learning points ▸ Adrenocortical carcinoma is a rare cause of inferior vena cava (IVC) tumour thrombus.

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“…One out of three patients with adrenocortical carcinoma presents with involvement of the venous system and inferior vena cava (IVC) thrombus (2). Tumours of the right adrenal gland are more likely to involve the IVC, due to the right adrenal vein directly draining into it (3).…”

Section: Introductionmentioning

confidence: 99%

Surgical management of adrenal tumours extending into the right atrium

et al. 2019

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This paper discusses the surgical approach for the treatment of adrenal tumours extending into the right atrium (RA), using a cardio-pulmonary bypass (CPB) associated with deep hypothermic circulatory arrest (DHCA). Pre-operative planning and surgical steps are described in details. The association of CPB with hypothermic circulatory arrest (HCA) provides a bloodless operating field, direct intra-vascular vision, reduces the risk of embolization and allows extensive inferior vena cava (IVC) or RA repair in cases of infiltration of the vascular wall. Establishing a dedicated multidisciplinary team with experience in managing these challenging cases is fundamental to offer treatment to patients with advanced disease, who would otherwise risk being turned down for surgery. A close collaboration between general and cardiac surgeons and a deep understanding of the surgical procedure steps are fundamental to safely performing these procedures. We advocate centralising adrenal surgery in a small number of units with adequate multidisciplinary support.

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Adrenal Tumors with Venous Thrombosis: A Single-Institution Experience

Cited by 11 publications

References 23 publications

Arterial thrombosis in unusual sites: A practical review

Arterial thrombosis in unusual sites: A practical review

Adrenocortical carcinoma with inferior vena cava tumour thrombus: multidetector CT (MDCT) evaluation and management

Surgical management of adrenal tumours extending into the right atrium

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