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TUMORA MEDIASTINALA Prezentare de caz

TUMORA MEDIASTINALA Prezentare de caz. Prof.dr.Dragomir Cristian Conf.dr.Lidia Ionescu Dr.Irina Trifescu Dr.Cozmin Radulescu. Right eyelid ptosis. Prezentare de caz. ANP, 41 ani, asimptomatic 2002-descoperire incidentala la RxT.-opacitate hilara stinga Recomandare de CT-torace.

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TUMORA MEDIASTINALA Prezentare de caz

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  1. TUMORA MEDIASTINALAPrezentare de caz Prof.dr.Dragomir Cristian Conf.dr.Lidia Ionescu Dr.Irina Trifescu Dr.Cozmin Radulescu

  2. Right eyelid ptosis

  3. Prezentare de caz • ANP, 41 ani, asimptomatic • 2002-descoperire incidentala la RxT.-opacitate hilara stinga • Recomandare de CT-torace

  4. CT-toraceFormatiune mediastinala bine delimitata

  5. Thymus-WNL

  6. CT torace- formatiune 58/39 mm.,neomogena, bine incapsulata, situata intre trunchiul a.pl., pericard, pleura mediastinala stinga

  7. CT aspect of the mass

  8. CT aspect of the mass

  9. Aspectul evoca:1.chist pericardic remaniat?2. dilatatie miocardica sau vascularaRecomandare- explorare echo. doppler

  10. Case report • 2009 ian.- spitalizat cl.neurologie, Iasi- cu miastenia gravis Oss.IIB aparuta brusc in urma cu 7 zile: disfagie, disfonie, ptoza palpeprala dr., fatigabilitate musculara • Ex.ORL- pareza corzi vocale bilateral • EMG- negativ • Ac.antiR.ACh- 23,85(n<0,25) • 3 tb.mestinon/zi • Investigatii CT torace • echodopller- cavitatile cordului nornale, kinetica normala.La baza cordului in raport cu Ao.asc., A.PL., pericard, formatiune de 53/71mm.fara semnal dopller la interior

  11. Investigations • Ex.clinic: TA-110/70 mm. Hg., P=72/min.ritmic • Ex.clinic neurologic: dipareza faciala de tip periferic cu lipsa pliurilor de la niv.fruntii, ptoza palpebrala ce se accentueaza dupa efort,diplopie, disfonie, tulburari de deglutitie,fatigabilitate musculara accentuata de efort • Test miostin + • Ex.EMG- negativ • CT cranio-cerebral- asimetrie ventriculara posibil constitutionala • CT torace- formatiune rotund ovalara 6/6/5,3 cm. Bine delimitata cu perete fin cu mici calcificari la nivel parietal, localizata in etajul mijlociu si inferior mediastin anterior, intre tr. A.pl. Cu limita de separatie, pericard sting, aorta ascendenta cu plan de separatie, pleura mediastinala posterior: a.pl.stg. Si bronsia lobara stinga fara elemente de invazie. In 1/3 sup. Aspect neomogen cu densitati solide si lichide

  12. Diagnosis - 2009 Chist pleuro-pericardic sting cu aceleasi dimensiuni ca in 2002 dar cu posibila degenerare in 1/3 sup.

  13. Echo. Doppler cord • VS nedilatat, kinetica normala • Cavitati drepte nedilatate • La baza cordului in raport cu Ao.asc. A.P., pericard sting, formatiune bine delimitata de 71/53 mm., continut aparent solid fara semnal doppler la interior, ce nu comprima cavitatile cordului sau vasele mari.

  14. Echo. Doppler cord • VS nedilatat, kinetica normala • Cavitati drepte nedilatate • La baza cordului in raport cu Ao.asc., A.P., pericard sting, formatiune bine delimitata de 71/53 mm., continut aparent solid fara semnal doppler la interior, ce nu comprima cavitatile cordului sau vasele mari

  15. Tratament • Mestinon, 60 mg. Tds. • PDN 5mg./zi • KCl-1g/zi Ameliorarea simtomatologie miastenice sub tratament anticolinesterazic

  16. Aspect CT - 2009

  17. Loja timica

  18. Calcificari marginale

  19. CT- FORMATIUNE ROTUNDA DE 6/6/5,3 CM. BINE DELIMITATA,LOCALIZATA IN ETAJUL MIJLOCIU SI INFERIOR AL MEDIASTINULUI ANTERIOR, INTRE TR.A.PL.,AO.ASC., PLEURA MEDIASTINALA

  20. OP.IAN.2009

  21. Incision

  22. Incision

  23. Incision

  24. Sternotomy

  25. Sternotomy

  26. Ecartare

  27. Ecartare

  28. Disectia mediastinului anterior

  29. Dissection

  30. Dissection

  31. Dissection

  32. Dissection

  33. Left innominate vein

  34. Complete resection

  35. Left pleurectomy

  36. Sternoraphy

  37. Sternoraphy

  38. Suturing the presternal fascia

  39. Suturing presternal fascia

  40. Mediastinal drainage

  41. Separate skin suture

  42. Surgical specimen

  43. Evolutie postoperatorie • La o luna –tratament cu PDN-30mg/zi si mestinon 3tb/zi cu controlul miasteniei. • Are putere pentru viata obisnuita, inca in ITM • Revine ptr. Control AC.antiR, CT, Scinti peste 6 luni.

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