This video illustrates the operative approach used to resect an unusual liver mass located at the cavoatrial junction. Hypothermia circulatory arrest with antegrade cerebral perfusion was used to allow for exposure, resection, and repair.
This video illustrates the operative approach used to resect an unusual liver mass located at the cavoatrial junction. Hypothermia circulatory arrest with antegrade cerebral perfusion was used to allow for exposure, resection, and repair.
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A very interesting unique case; intervention carefully planned and perfectly carried out. Operative field perfectly exposed ; outstanding, perfectly clear presentation. Final treatment of the clinical problem with prevention of possible risk of future impairment of blood flow to the heart.
I just wonder if subsequent 6 months CT/RM mass volume/feature monitoring with or without CT-guided needle biopsy could have been an other possible option before surgery.
Thanks for sharing this very interesting case and congratulation for the perfect, elegant operation with stable prevention of potential long term clinical problems
Thank you for your kind comments. I think it is quite a valid question as to whether surgery could have been avoided in this patient, since the mass ultimately was benign. Preoperative CT scanning and MRI was not helpful in distinguishing the nature of the mass. In addition, this pathology had never been reported previously in the IVC location. Our interventional radiologists did not feel that the mass was accessible for a safe biopsy. Moreover, the mass was causing near-complete obstruction of the IVC. One cannot know whether ultimately the mass would have resulted in clinical symptoms of obstruction, but the possibility needs to be entertained. You raise a great point, and one can reasonably ask the question as to whether this patient should have been observed over time.