Soft Tissue Neoplasms Causing Apparent Venous Thoracic Outlet Syndrome

A Primary Mediastinal Monophasic Spindle-Cell Synovial Sarcoma with Superior Venacaval Obstruction

Primary mediastinal sarcoma is a rare tumour that usually presents with nonspecific symptoms such as hoarseness, dyspnoea, and chest pain. Superior vena cava (SVC) syndrome is an extremely uncommon complication that is caused by the compression, invasion, and thrombosis of the SVC or brachiocephalic veins. SVC syndrome can present as asymptomatic cases or as rare life-threatening emergencies with upper airway obstruction and increased intracranial pressure. This report describes the case of a 58-year-old female who presented with swelling of the face, neck, and upper limbs associated with dyspnoea on exertion. The radiological investigations revealed a large well-defined central necrotic peripherally enhancing lesion in the superior mediastinum extending anteriorly with the compression of brachiocephalic veins. A histopathological examination detected spindle cells arranged in fascicles with nuclear atypia with immunohistochemistry positive for creatine kinase (CK), smooth muscle actin (SMA), desmin and CD99. These findings established the diagnosis of a mediastinal monophasic synovial sarcoma with SVC obstruction. The patient was initiated on palliative radiotherapy for the management of the SVC, followed by systemic biological treatment with the tyrosine kinase inhibitor pazopanib, and was clinically improved. It is essential to promptly diagnose and treat this condition, especially when SVC syndrome manifests.

Duplex ultrasound in the evaluation of venous and arterial thoracic outlet syndrome

We are reporting a case of thoracic outlet syndrome and the value of duplex in the diagnosis of this syndrome.

Venous thoracic outlet syndrome secondary to arterial stent implantation: A case report

RATIONALE

Venous thoracic outlet syndrome (VTOS) secondary to subclavian arterial stent implantation is extremely rare. Here, we firstly report this disease and the endovascular intervention using covered-stents.

PATIENT CONCERNS

An 80-year-old man who had received an acceptable stent implantation for the treatment of a right subclavian arteriovenous malformation (AVM), presented with a gradually increasing swelling and pain in his right upper extremity.

DIAGNOSIS

The patient was diagnosed with right VTOS and recurrent subclavian AVM following ultrasonography and computed tomographic angiography.

INTERVENTIONS

We positioned a covered-stent in the subclavian artery to block the feeding arteries and successfully embolized the remaining branches with coils. Next, we performed successful dilation 3 times, followed by the positioning of another covered-stent in the right subclavian vein.

OUTCOMES

The patient was free of all symptoms and the imaging procedures confirmed an acceptable thrombosis of the AVM with patent stents in the right subclavian artery and vein during the 6-month follow-up.

LESSONS

Venous stent implantation is an alternative to treat VTOS caused by subclavian arterial stents and it is essential to pay more attention to the incidence of VTOS following arterial stent implantation in the subclavian artery.

Axillary Chest Wall Hibernoma With Intrathoracic Extension Presenting as Thoracic Outlet Syndrome

Hibernomas are rare benign soft tissue tumors derived from brown fat. This case report describes an axillary hibernoma with intrathoracic extension, presenting as a thoracic outlet syndrome. A multimodality imaging series illustrates the classic radiologic features of hibernoma as well as its highly unusual pattern of growth. The latter resulted in TOS with vascular displacement and osseous remodeling, features that are generally absent in lipomatous masses. Detailed preoperative imaging allowed to plan a single surgical procedure in which an extrathoracic axillary approach was combined with intrathoracic video-assisted thoracic surgery.