title: Residual Inferior Vena Cava Thrombus Detected by Transesophageal Echocardiography After Resection of a Malignant Adrenal Mass.
abstract: A 43-year-old woman with a history of the Cushing syndrome secondary to adrenocortical carcinoma presented to the operating room for right adrenalectomy, hepatectomy, nephrectomy, and inferior vena cava (IVC) thrombectomy. Initial intraoperative transesophageal echocardiogram (TEE) confirmed the presence of an IVC tumor below the hepatic veins. Total vascular exclusion of the liver was necessary to perform the operation. A repeat TEE showed a residual thrombus within the IVC prompting an additional cavotomy to successfully remove the entire mass. The remainder of the procedure finalized uneventfully. The case highlights the importance of TEE monitoring for noncardiac surgery with thrombotic involvement of the IVC.
authors.affiliation: From the Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
authors.forename: Nelson H
authors.initials: NH
authors.lastname: Burbano
authors.forename: Claudene
authors.initials: C
authors.lastname: Vlah
authors.forename: Maged
authors.initials: M
authors.lastname: Argalious
mesh_terms: D000306:Adrenal Cortex Neoplasms / Q000150:complications / Q000601:surgery*; D018268:Adrenocortical Carcinoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D003480:Cushing Syndrome / Q000209:etiology; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D017131:Thrombectomy / Q000379:methods; D014682:Vena Cava, Inferior / Q000473:pathology; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery