26264228 Visualization

A 56 Age - year Age - old Age man Sex presented Clinical_event with a 2 Duration - year Duration history of dysphagia History .
He was diagnosed with a middle Biological_structure thoracic Biological_structure oesophageal Biological_structure squamous Disease_disorder cell Disease_disorder carcinoma Disease_disorder by both a gastroscopy Diagnostic_procedure and a biopsy Diagnostic_procedure .
A chest Biological_structure computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan showed an enlarged Sign_symptom azygos Biological_structure vein Biological_structure (a diameter of 2.5 Distance cm Distance ) that was a continuation Sign_symptom of the IVC Biological_structure (Fig.1a, b).
A CT Diagnostic_procedure scan of the abdomen Biological_structure showed a defect Sign_symptom in the suprarenal Biological_structure segment Biological_structure of Biological_structure the Biological_structure inferior Biological_structure vena Biological_structure cava Biological_structure and direct Detailed_description drainage Sign_symptom of the hepatic Biological_structure vein Biological_structure into the right Biological_structure atrium Biological_structure .
After consultation Clinical_event with the thoracic Nonbiological_location surgery Nonbiological_location department Nonbiological_location clinicians Nonbiological_location and the anaesthesiology Nonbiological_location department Nonbiological_location , we decided to perform a McKeown Detailed_description oesophagectomy Therapeutic_procedure .
The patient was anaesthetised Therapeutic_procedure with a double Detailed_description - lumen Detailed_description tube Detailed_description and underwent a standard Detailed_description posterolateral Detailed_description thoracotomy Therapeutic_procedure by traditional Detailed_description open Detailed_description surgery Detailed_description .
We first performed the jugular Biological_structure and Biological_structure femoral Biological_structure vein Biological_structure percutaneous Detailed_description puncture Detailed_description to create a veno Therapeutic_procedure - venous Therapeutic_procedure bypass Therapeutic_procedure and then connected the pressure Therapeutic_procedure sensor Therapeutic_procedure system Therapeutic_procedure to the monitor.
The monitor displayed the real-time pressure value of the jugular vein and the femoral vein.
Macroscopically Diagnostic_procedure , the diameter Diagnostic_procedure of the azygos Biological_structure arch Biological_structure was approximately 2.5 Distance cm Distance (Fig.1c), and the superior Detailed_description edge Detailed_description of the tumour Sign_symptom adhered tightly to the arch Biological_structure of Biological_structure the Biological_structure azygos Biological_structure vein Biological_structure .
When the arch Biological_structure of Biological_structure the Biological_structure azygos Biological_structure vein Biological_structure was pulled Therapeutic_procedure with a rubber Detailed_description hose Detailed_description to dissociate it from the carcinoma Coreference , the monitor showed that the femoral Biological_structure vein Biological_structure pressure Diagnostic_procedure increased Lab_value to 52 Lab_value mmH2O Lab_value ; the pressure returned to a normal Lab_value value Lab_value when we opened the bypass Coreference between the femoral vein and the jugular vein (Fig.2).
The surgery was performed smoothly, without injury Disease_disorder to the azygos Biological_structure vein Biological_structure , and the postoperative Diagnostic_procedure recovery Diagnostic_procedure was uneventful Lab_value .
The pathology Diagnostic_procedure of the resected Detailed_description specimen Detailed_description showed a poorly Lab_value differentiated Lab_value squamous Disease_disorder cell Disease_disorder carcinoma Disease_disorder and no evidence of malignancy Sign_symptom in 15 Lab_value of the lymph Biological_structure nodes Biological_structure .
After 5 Duration months Duration of follow Clinical_event - up Clinical_event , the patient was asymptomatic Sign_symptom , with no evidence of recurrent Disease_disorder disease Disease_disorder either clinically or on CT Diagnostic_procedure .