SINH THIẾT QUA DA ĐƯỜNG NỘI MẠCH KẾT HỢP CAN THIỆP ĐIỀU TRỊ MỘT TRƯỜNG HỢP HỘI CHỨNG TĨNH MẠCH CHỦ TRÊN BÁO CÁO TRƯỜNG HỢP LÂM SÀNG

Abstract

Superior vena cava syndrome often has a mediastinal malignant origin, although it is not commonly found in clinical practice. The cytology diagnosis of any mediastinal lesion is quite challenging because of the difficulty to perform any specimen collection procedure in such location. Moreover, deep lesions that are surrounded with or have already invaded major blood vessels, make it become even harder to perform a CT or Ultrasound-guided percutaneous biopsy, as well as increasing post-procedure complication risks. Therefore, mediastinoscopy is usually the first choice to collect samples whenever lesions are found in such area, especially when surgical therapy is not recommended anymore. However, here, we performed a Forcep-supporting percutaneous endovascular biopsy on a deep mediastinal lesion, which invaded the superior vena cava-causing a superior vena cava syndrome. During the intervention, we also placed a covered stent to resolve the invasion-induced vena cava stenosis, which accomplished a diagnosis-treatment integration benefit, as the patient’s symptoms improved significantly afterwards. The cytology result demonstrated a Diffuse Large B-cell Lymphoma, and our patient had his chemotherapy treatment started right away.