[Neoplastic thrombosis of the inferior vena cava involving the right atrium caused by adrenal cortical carcinoma. A new indication for vascular exclusion of the liver].
A large malignant adrenocortical carcinoma extending to the inferior vena cava and right atrium presented in the form of hemoptysis. Magnetic resonance imaging allowed precise evaluation without any other invasive procedure. Cardiopulmonary bypass is usually employed in these circumstances to remove the cavo-atrial thrombus. This approach may be advantageously replaced by the use of total vascular exclusion of the liver. The only unusual feature of the procedure is that the upper caval clamp is applied across the right atrium. Major collateral circulation due to caval thrombosis allows complete resection of the inferior vena cava up to the hepatico-caval confluence without the need for prosthetic replacement. After an uneventful postoperative course, malignant spread despite chemotherapy with op'-DDD led to death 4 months after surgery.
Huguet
C
C
Département de Chirurgie, Centre Hospitalier Princesse Grâce, Monaco, Principauté de Monaco.
Caporossi
M
M
Gavelli
A
A
Harb
J
J
McNamara
M
M
D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D017809:Fatal Outcome; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*
Thrombose néoplasique de la veine cave inférieure étendue à l'oreillette droite en rapport avec un corticosurrénalome. Une nouvelle indication de l'exclusion vasculaire du foie.