A case of thymic carcinoma resected by preserving collateral circulation tract via azygos vein with combined resection of superior vena cava and bilateral brachiocephalic vein

Abstract

In the case of surgery for advanced thymic epithelial tumors invading the superior vena cava (SVC) or left brachiocephalic vein (LBCV), combined resection and revascularization with a vascular graft may be required. However, the graft may be obstructed due to thrombosis and anatomical factors. We report a case of resection of thymic carcinoma infiltrating SVC and LBCV, while preserving the collateral circulation via the azygos vein. An 80-year-old woman was referred to our hospital after being diagnosed with an anterior mediastinal tumor. Enhanced computed tomography (CT) showed the tumor obstructing SVC and LBCV. Although upper body swelling and facial edema were absent, three-dimensional reconstruction CT showed an expanded azygos vein and marked collateral circulation. Focusing on preservation of the collateral circulation via the azygos vein, we resected the tumor that infiltrated SVC and LBCV without vascular reconstruction. The final pathological diagnosis was thymic carcinoma. Postoperative CT showed preserved flow through the azygos vein without compression. In cases of advanced thymic tumor infiltrating SVC and LBCV with marked collateral circulation via the azygos vein, preservation of the azygos vein may be an alternative to vascular reconstruction.