A 56-year-old man presented with a 2-year history of dysphagia. He was diagnosed with a middle thoracic oesophageal squamous cell carcinoma by both a gastroscopy and a biopsy. A chest computed tomography (CT) scan showed an enlarged azygos vein (a diameter of 2.5 cm) that was a continuation of the IVC (Fig. ). A CT scan of the abdomen showed a defect in the suprarenal segment of the inferior vena cava and direct drainage of the hepatic vein into the right atrium.\nAfter consultation with the thoracic surgery department clinicians and the anaesthesiology department, we decided to perform a McKeown oesophagectomy. The patient was anaesthetised with a double-lumen tube and underwent a standard posterolateral thoracotomy by traditional open surgery.\nWe first performed the jugular and femoral vein percutaneous puncture to create a veno-venous bypass and then connected the pressure sensor system to the monitor. The monitor displayed the real-time pressure value of the jugular vein and the femoral vein.\nMacroscopically, the diameter of the azygos arch was approximately 2.5 cm (Fig. ), and the superior edge of the tumour adhered tightly to the arch of the azygos vein. When the arch of the azygos vein was pulled with a rubber hose to dissociate it from the carcinoma, the monitor showed that the femoral vein pressure increased to 52 mmH2O; the pressure returned to a normal value when we opened the bypass between the femoral vein and the jugular vein (Fig. ). The surgery was performed smoothly, without injury to the azygos vein, and the postoperative recovery was uneventful. The pathology of the resected specimen showed a poorly differentiated squamous cell carcinoma and no evidence of malignancy in 15 of the lymph nodes.\nAfter 5 months of follow-up, the patient was asymptomatic, with no evidence of recurrent disease either clinically or on CT.
This is a 1-month-old male diagnosed with transposition of big vessels, treated with ASA and carvedilol; he was sent to a multispecialty hospital when he was 11 years old. Here, a CT angiogram was donde revealing an ambiguous situs with levocardia, two bilobed lungs, left liver, right stomach, right polysplenia, interruption of the IVC with hemiazygos continuation, four pulmonary veins reached the left atrium, presenting two SVC that reached the RA and IVC interruption with hemiazygos continuation to the left SVC. An ASD was observed, the left atrium communicated with a small and inferiorly situated ventricle, the RA communicated with a larger ventricle of superior situation, with an interventricular communication that can be taken as a single ventricle, transposition of great vessels, the aorta in front of the pulmonary artery. The suprahepatic veins drained directly with a common trunk to the RA. ().\nWith these findings, a pulmonary artery–left vena cava anastomosis was performed; his postoperative course was uneventful and was discharged home.\nFour years later, the patient consulted because of cyanosis, growth retardation and pulse oximetry of 70%; therefore, a second surgery was decided after right SVC ligation pulse oximetry raised to 90%.