Subxiphoid dual-port thymectomy for thymoma in a patient with post-aortic left brachiocephalic vein
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CASE REPORT
Subxiphoid dual‑port thymectomy for thymoma in a patient with post‑aortic left brachiocephalic vein Masahito Naito1 · Mototsugu Ono1 · Shoko Hayashi1 · Yoshio Mastui1 · Kazu Shiomi1 · Yukitoshi Satoh1 Received: 2 April 2020 / Accepted: 4 July 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Post-aortic left brachiocephalic vein (PALBV) is one of the rare congenital vessel abnormalities associated with congenital heart disease. As only a few reports of surgical treatment for thymic tumor in patients with PALBV are available, this study reports the case of a patient with PALBV who underwent surgical treatment for thymoma. In a 60-year old woman, a nodule in the anterior mediastinum was detected on chest computed tomography (CT) during examination for arrhythmia. Thymoma was suspected, and surgical resection was considered. PALBV was detected on a contrast CT scan before surgery. Videoassisted thoracoscopic surgery was used to perform thymectomy using the subxiphoid dual-port approach. This method provided an appropriate view of the operative field and made it easy to confirm the presence of PALBV and identify the thymic veins branching off from the internal thoracic vein. Keywords Subxiphoid dual-port thymectomy · Minimally invasive surgery · Thymoma · Post-aortic left brachiocephalic vein · Brachiocephalic vein
Introduction
Case
To safely perform surgery for a mediastinal tumor, recognition of vascular abnormalities by a surgeon is important. Post-aortic left brachiocephalic vein (PALBV) is a rare congenital venous malformation. Few reports are available in the English literature about the surgical treatment of thymic tumor in patients with PALBV [1]. In this case, total thymectomy using video-assisted thoracoscopic surgery (VATS) was performed in a patient who had a thymoma and PALBV. The single-port technique via the subxiphoid approach was used with a 5-mm-sized port on the right side of the chest to achieve minimal pain and an optimal cosmetic outcome. This study reports the first case of thymectomy using VATS via the subxiphoid approach in a patient having thymoma with PALBV.
A 60-year old woman underwent chest computed tomography (CT) prior to ablation for arrhythmia, which revealed an irregularly shaped nodule measuring 23-mm in the anterior mediastinum (Fig. 1a). Chest magnetic resonance imaging (MRI) revealed that the nodule did not invade surrounding structures in the anterior mediastinum (Fig. 1b). Positron emission tomography (PET) indicated moderate accumulation (maximum standardized uptake value, 2.7) in the nodule. No detectable metastases were present in other organs. Chest CT with contrast medium revealed that the PALBV passed caudally to the aortic arch and flowed into the superior vena cava (Fig. 1c). Laboratory data were unremarkable, and tumor markers, such as squamous cell carcinoma antigen (SCC) and carcinoembryonic antigen (CEA), were within normal limits. Similarly, anti-acetylcholine receptor antibody testing was negative. The nodule was suspected to b
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