title: Floating left innominate vein neoplastic thrombus: a rare case of mediastinal extension of follicular thyroid carcinoma.
abstract: OBJECTIVE
  We report a case of advanced follicular thyroid cancer with innominate vein involvement. To our knowledge, this seems to be the first case treated in emergency surgery, reported in literature.
  
  
  METHODS
  A 59-year-old woman with a five-year history of a large and mainly right-sided cervical mass presented with dyspnea, unilateral arm swelling, facial flushing, and venous congestion. An emergency computed tomography scan revealed a thyroid mass extending into the upper mediastinum with displacement and compression of the right jugular vein and carotid artery and apparent adherence to the superior vena cava and left innominate vein.
  
  
  RESULTS
  An emergency total thyroidectomy was performed by means of a sternotomy. The lower portion of the retrosternal goiter projected directly into the left innominate vein, with tumor floating in its lumen. Removal of the neoplastic thrombus was performed, through an incision in the vein, en bloc with the thyroid mass. Both goiter and thrombus were completely replaced by follicular carcinoma.
  
  
  CONCLUSIONS
  Accurate preoperative assessment through contrast-enhanced computed tomography is strongly suggested in the presence of enlarged thyroid gland extending into the mediastinum whenever angioinvasion is suspected. This could prevent blinded maneuvers such as digital externalization of the thoracic component of the gland, which can be fatal in cases of cervico-mediastinal goiter extending into great cervical or mediastinal veins.
authors: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy ilariafrn@libero.it.
authors: I F
authors: IF
authors: Franco
authors: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors: A
authors: A
authors: Gurrado
authors: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors: G
authors: G
authors: Lissidini
authors: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors: G
authors: G
authors: Di Meo
authors: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors: A
authors: A
authors: Pasculli
authors: Department of Biomedical Sciences and Human Oncology, Unit of Endocrine, Digestive and Emergency Surgery, University Medical School "A. Moro" of Bari, Bari, Italy.
authors: M
authors: M
authors: Testini
mesh_terms: D000792:Angiography; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008479:Mediastinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008875:Middle Aged; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery
keywords: Thyroid carcinoma; cancer; endocrine surgery; follicular carcinoma; neoplastic thrombus