Azygos Vein Aneurysm Mimicking a Mediastinal Mass

Savu, Cornel; Melinte, Alexandru; Bălescu, Irina; Bacalbaşa, Nicolae

doi:10.21873/invivo.12019

Cited by 20 publications

(19 citation statements)

References 36 publications

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“…Some authors consider that the most common primary pleural tumors are solitary pleural fibromas; however, leiomyoma must be included as an option during the differential diagnosis, even though it is a rare pathology (35). In fact, during the differential diagnosis other types of tumors should also be taken into consideration, such as neuromas, secondary lesions or other intrapleural tumoral masses (36,37). In our case, we chose a cautious intraoperative approach using a wide resection with oncological margins, as if we were removing a solitary pleural fibroma.…”

Section: Discussionmentioning

confidence: 99%

Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence

Savu

Melinte²,

Gibu³

et al. 2021

In Vivo

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Background/Aim: Leiomyoma is a rare benign tumor originating from smooth muscle fibres. In the respiratory tract, these tumors are rare and in the pleura, cases are exceptional, with only a few reported so far. This is the main reason we decided to present this case of primary leiomyoma of the visceral pleura. Case Report: We present a case of a 51-year-old asymptomatic patient who, during a routine medical examination using standard chest radiography, presented with a 3 by 2 cm homogenous mass in the right superior pulmonary area, tangent to the chest wall (same level with the 3 rd rib). Further investigation using computed tomography (CT) in the chest confirmed the presence of a 31/18 mm solid mass in the right upper lobe, in contact with the parietal pleura. Surgery was performed for two reasons: i) removal of the tumoral mass and ii) establishing a histopathological diagnosis. Intraoperatively, a well-defined, homogenous, ivory white non-infiltrating mass was discovered in the right upper lobe on the visceral pleura and in close proximity to the minor fissure. The mass was removed with negative surgical margins and was left with healthy tissue. Histopathological examination and immunohistochemistry came as a surprise, establishing our diagnosis of leiomyoma. Conclusion: Primitive pleural leiomyoma must remain a possibility when considering the differential diagnosis of pleural tumors. The main course of treatment is complete surgical resection. In our case, longterm follow up did not present any local recurrence.Leiomyoma is a tumor originating in smooth muscular fibres and can occur anywhere in the body where this cell type exists. Leiomyomas are part of the mesenchymal tumor category. Most often, these tumors are present in the uterus, esophagus and small intestine (1, 2). The first description of leiomyoma belongs to Wirshaw in 1854 (1) while Steinard reported the first case of pulmonary leiomyoma in 1939 in a patient that also presented with a uterine fibroma (3). In 1958, Kloepfer described the presence of hereditary leiomyomatosis (2). Other hereditary leiomyomatosis have since been described with multiple simultaneous locations (4); however, the presence in the respiratory tract of a leiomyoma is rare, representing 2% of benign tumors found in this region (5,6).Primary pulmonary leiomyoma was first described in 1907 as a standalone pathology (7), with the first case of pulmonary leiomyoma being reported by Forkel, in 1910 (8).

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Section: Discussionmentioning

confidence: 99%

Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence

Savu

Melinte²,

Gibu³

et al. 2021

In Vivo

Self Cite

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“…Dasika et al [ 13 ] and De Palma et al [ 14 ] reported cases of leiomyosarcoma of the azygos vein and epithelioid hemangio-endothelioma, respectively, and they advocated aggressive surgical therapy. Savu et al [ 15 ] reported that in cases of azygos venous aneurysm with complete thrombosis, surgery was recommended and must be performed with extreme care in order to prevent intraoperative embolism. Our patient had symptoms of back pain, chest tightness, and choking.…”

Section: Discussionmentioning

confidence: 99%

Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report

Wang¹,

Yang²,

Xu³

et al. 2021

WJCC

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BACKGROUND Azygos vein aneurysms are extremely rare, and their pathogenesis is not clear. The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance. There are few reports on the diagnosis of and treatment strategy for this disease. Moreover, the choice of therapeutic schedule and the treatment window are controversial. CASE SUMMARY We report a case of azygos vein arch aneurysm in a 53-year-old woman. The patient had symptoms of back pain, chest tightness, and choking. Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum, which was connected to the superior vena cava. The enhancement degree in the venous phase was the same as that of the superior vena cava. The patient received video-assisted thoracoscopic surgery. After the operation, her back pain disappeared, and her dysphagia and chest tightness were also significantly relieved. The postoperative pathology confirmed hemangioma. The patient was discharged on the seventh day after surgery without any comp-lications. CONCLUSION Some patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea. Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms. In addition, despite the difficulty and risk of surgery, thoracoscopic surgery for azygos vein aneurysms is completely feasible.

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“…The routine paraclinical imaging examination for diagnosis and for the evaluation of extension is the CT examination ( Fig. 2 ) ( 22 , 27 , 32 ). Thus, a CT examination can show specific signs of parietal thoracic necrotizing fasciitis: signs of parietal collections, edema in the subcutaneous and fatty tissue, gas collections locally or with locoregional extension.…”

Section: Discussionmentioning

confidence: 99%

Necrotizing fasciitis of the chest wall: A clinical case report and literature review

Petreanu¹,

Constantin

Iosifescu

et al. 2021

Exp Ther Med

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Necrotizing fasciitis of the chest wall is a very rare pathology, but with significant mortality, representing a therapeutic challenge. All international reports indicate the need for early diagnosis and an aggressive medical-surgical attitude in order to improve the prognosis. In addition to a review of literature, we present a case developed secondary to a thoracic pleural drainage for pyopneumothorax associated with significant bronchopleural fistula in a destroyed tuberculous left lung. Along with medical treatment, extensive surgical debridement was required. Despite drainage incisions and negative pressure wound therapy (NPWT), the evolution of the fasciitis was difficult, due to bronchopleurocutaneous fistula. Thus, the Azorin procedure (transcervical mediastinoscopic closure of the left main bronchus) was performed. Once this procedure was completed, the inflammatory phenomena were controlled which allowed for a second step consisting of left pneumonectomy, with the application of specific methods for the prevention of bronchial fistula. The clinical case was a therapeutic challenge requiring a complex, staged, multidisciplinary approach due to both the immunocompromised terrain and the severity of the lesions. In conclusion, early recognition and aggressive and combined application of medical and surgical treatment methods can ensure therapeutic success.

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Azygos Vein Aneurysm Mimicking a Mediastinal Mass

Cited by 20 publications

References 36 publications

Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence

Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence

Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report

Necrotizing fasciitis of the chest wall: A clinical case report and literature review

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