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Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report

Background: Mediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of t...

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Autores principales: Ferrari, Paolo Albino, Fusaro, Federico, Ferrari, Antonio, Tamburrini, Alessandro, Grimaldi, Giulia, Santoru, Massimiliano, Zappadu, Sara, Tanda, Elisabetta, Nemolato, Sonia, Comelli, Simone, Cherchi, Roberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9863118/
https://www.ncbi.nlm.nih.gov/pubmed/36676715
http://dx.doi.org/10.3390/medicina59010091
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author Ferrari, Paolo Albino
Fusaro, Federico
Ferrari, Antonio
Tamburrini, Alessandro
Grimaldi, Giulia
Santoru, Massimiliano
Zappadu, Sara
Tanda, Elisabetta
Nemolato, Sonia
Comelli, Simone
Cherchi, Roberto
author_facet Ferrari, Paolo Albino
Fusaro, Federico
Ferrari, Antonio
Tamburrini, Alessandro
Grimaldi, Giulia
Santoru, Massimiliano
Zappadu, Sara
Tanda, Elisabetta
Nemolato, Sonia
Comelli, Simone
Cherchi, Roberto
author_sort Ferrari, Paolo Albino
collection PubMed
description Background: Mediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of treatment remains controversial. Case presentation: Herein, we report the case of a hemangioma of the azygos vein arch in a 66-year-old woman who presented with dyspnea, chest discomfort, dysphagia, and weight loss. A simultaneous right chylothorax refractory to conservative management was found. A CT-guided biopsy of the mass was performed, and it confirmed the vascular nature of the lesion. Therefore, the patient underwent an angiography followed by endo-vascular embolization. Three days later, thoracoscopic surgical resection of the mass and the repair of the chyle leakage were performed safely. The patient was discharged uneventfully on postoperative day seven, with complete resolution of all the presenting symptoms. Conclusions: Treatment of symptomatic mediastinal hemangiomas could be mandatory, but a thorough multidisciplinary approach to these rare malformations is essential. Despite the risk of intraoperative bleeding, selective endovascular embolization followed by thoracoscopic surgery allowed for a complete and safe resection with a good outcome.
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spelling pubmed-98631182023-01-22 Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report Ferrari, Paolo Albino Fusaro, Federico Ferrari, Antonio Tamburrini, Alessandro Grimaldi, Giulia Santoru, Massimiliano Zappadu, Sara Tanda, Elisabetta Nemolato, Sonia Comelli, Simone Cherchi, Roberto Medicina (Kaunas) Case Report Background: Mediastinal hemangiomas are rare, and their etiology remains unclear. Most patients affected have no pathognomonic clinical symptoms, and the diagnosis is often incidental. Due to the paucity of the available literature regarding the management of this disease, the choice and timing of treatment remains controversial. Case presentation: Herein, we report the case of a hemangioma of the azygos vein arch in a 66-year-old woman who presented with dyspnea, chest discomfort, dysphagia, and weight loss. A simultaneous right chylothorax refractory to conservative management was found. A CT-guided biopsy of the mass was performed, and it confirmed the vascular nature of the lesion. Therefore, the patient underwent an angiography followed by endo-vascular embolization. Three days later, thoracoscopic surgical resection of the mass and the repair of the chyle leakage were performed safely. The patient was discharged uneventfully on postoperative day seven, with complete resolution of all the presenting symptoms. Conclusions: Treatment of symptomatic mediastinal hemangiomas could be mandatory, but a thorough multidisciplinary approach to these rare malformations is essential. Despite the risk of intraoperative bleeding, selective endovascular embolization followed by thoracoscopic surgery allowed for a complete and safe resection with a good outcome. MDPI 2022-12-31 /pmc/articles/PMC9863118/ /pubmed/36676715 http://dx.doi.org/10.3390/medicina59010091 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Ferrari, Paolo Albino
Fusaro, Federico
Ferrari, Antonio
Tamburrini, Alessandro
Grimaldi, Giulia
Santoru, Massimiliano
Zappadu, Sara
Tanda, Elisabetta
Nemolato, Sonia
Comelli, Simone
Cherchi, Roberto
Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report
title Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report
title_full Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report
title_fullStr Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report
title_full_unstemmed Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report
title_short Refractory Chylothorax Secondary to Sizeable Azygos Vein Hemangioma: Tailored Multimodal Treatment of a Challenging Case Report
title_sort refractory chylothorax secondary to sizeable azygos vein hemangioma: tailored multimodal treatment of a challenging case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9863118/
https://www.ncbi.nlm.nih.gov/pubmed/36676715
http://dx.doi.org/10.3390/medicina59010091
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