Rhythmic Shoulder Girdle Muscle Contractions as a Complication in Pacemaker Treatment

Abstract

The correct diagnosis with a good definition of the tumor limits is thus mandatory. Careful study of the clinical picture may be of considerable help in this respect. The symptoms indeed depend upon the level and extension of the mass. The different clinical symptoms are generally related to progressive occlusion of the inferior vena cava followed by development of collateral circulation. In previous reports, when the tumor was located in . the upper third of the inferior vena cava, Chiari's syndrome was observed with hepatomegaly, ascites and jaundice.s*6*7*8*lt-16 The origin of the hepatic vein was invaded by the tumor or occluded by antemortem thrombosis. He~atic failure was sometimes more dramatic when the occlusion of the hepatic vein was abrupt. Tumors located in the middle third of the inferior vena cava give rise to a nephrotic syndrome and renal failure.' Leiomvosarcoma located in the lower third of the inferior Gens cava are extremely difficult to diagnose. Very often, they extend to the peritoneum with no obstruction in the vena cava, but produce severe lumbar pain. It is only when the tumor grows inside the vessel that swelling of the legs may appear with a palpable abdominal mass. Cavography seems to be the most suitable method to reach the diagnosis and to obtain information as regards the tumor extent and location. This technique was used in two previous instances by Roussak and Heppelston6 and Deutsch and colleagues.21 In our patient inferior cavography revealed a defect of filling with many anastomotic vessels. The superior cavography showed extension of the tumor into the right atrium. Filling defects were also observed in peripheral branches of the pulmonary artery. Propagation into the right atrium was found in four cases so far.ls-151lg In all of them, the tumor arose in the upper third of the inferior vena cava. Resection of the tumor was reported in six ~ases.~*'J~-~~ The first operation was carried out by Melchiorl8 in 1921. Three patients survived the surgical procedure and were still alive between nine months and-one year after surgery.34.20