Simultaneous thrombectomy from pulmonary artery branches and inferior vena cava for left adrenocortical carcinoma
Skums A.V., Gabrielyan A.V., Gurin P.V., Symonov O.M., Kropelnytskyi V.V., Skums A.A.
Summary. We present a clinical case of successful simultaneous surgical treatment of a patient with left adrenocortical carcinoma (ACC) complicated by massive pulmonary embolism (PE) and inferior vena cava (IVC) tumor thrombosis. A 52-year-old patient diagnosed with left ACC, IVC thrombosis, and clinical manifestations of PE. Magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) revealed a 20-cm left adrenal tumor with tumor thrombosis of the left renal vein and IVC, as well as thrombi in both pulmonary artery branches. The PESI scale (Pulmonary Embolism Severity Index showed) a very high risk of death within 30 days (162 points). A simultaneous operation was performed: thrombectomy from pulmonary artery branches, left adrenalectomy, thrombectomy from the left renal vein and IVC. The postoperative period was uneventful. On day 14, the patient was discharged in satisfactory condition. Histopathology confirmed ACC with tumor thrombus. This clinical case demonstrates the possibility of successful simultaneous surgery for ACC with venous invasion and PE, provided timely diagnosis and a multidisciplinary team. Conclusion. Patients with locally advanced adrenal tumors with ascending tumor thrombosis of the inferior vena cava represent a complex group of patients with high perioperative risk, whose treatment should be carried out in multidisciplinary specialized centers.
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