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

Authors :
Paolo Albino Ferrari
Federico Fusaro
Antonio Ferrari
Alessandro Tamburrini
Giulia Grimaldi
Massimiliano Santoru
Sara Zappadu
Elisabetta Tanda
Sonia Nemolato
Simone Comelli
Roberto Cherchi
Source :
Medicina. 59:91
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

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.

Subjects

Subjects :
General Medicine

Details

ISSN :
16489144
Volume :
59
Database :
OpenAIRE
Journal :
Medicina
Accession number :
edsair.doi...........9523f3045013524f0611592aa366f702
Full Text :
https://doi.org/10.3390/medicina59010091