Bilateral Axillary Research Articles

Subclavian and axillary vessel anatomy: a prospective observational ultrasound study.

The primary objective of this study was to define the ultrasound-derived anatomy of the axillary/subclavian vessels. As a secondary objective, we evaluated the relationship between the vascular anatomy and demographic, anthropometric, and hemodynamic data of patients. This observational anatomical study used bedside ultrasound with 150 cardiac surgical patients in the operating room. Bilateral axillary and subclavian anatomy was determined using a high-frequency ultrasound probe with fixed reference points. Images were recorded and analyzed, and correlation with demographic, anthropometric, and hemodynamic data was performed. The images were adequate to evaluate potential anatomical variations in 97.4% of patients with a body mass index as high as 46.4kg·m-2. The mean (standard deviation) diameter of the axillary vein was 1.2 (0.3) cm on the right side and 1.1 (0.2) cm on the left side. The dimensions of the axillary vein were larger on the right side in 69% of patients. The vein was located directly over the artery in the mid-clavicular view in 67% of the patients and in lateral-clavicular view in only 7% of the patients. As we moved the probe laterally, the vein was lateralized in relation to the artery in 89% of patients. There was no significant correlation between the hemodynamic data and vessel size, although direct correlation was found between body mass index and the depth of the vessel (P<0.001). The axillary vein area was smaller in females than in males (P<0.002), and in 4% of patients, the axillary vein was in an aberrant position. In patients undergoing cardiac surgery, axillary vessel anatomy varied considerably, and the patients' hemodynamics could not predict the size of the axillary vessels. Only the patients' weight correlated moderately with the depth of the vein.

Limited Bilateral Advancement of the Sternocostal Head of Pectoralis Major for Sternal Reconstruction: Preserving the Axillary Fold

The introduction of well-vascularized flaps for infected sternotomy wound reconstruction has improved mortality rates dramatically. Multiple variations of the pectoralis major flap have been described in this context. However, unresolved limitations of this flap include poor cosmesis and problematic coverage of the inferior third of the sternotomy wound. We describe an approach to address these issues. The humeral attachments are preserved and bilateral muscles are advanced in a limited fashion. The left sternocostal head is advanced medially and rotated anticlockwise, using this portion to fill the upper half of the sternum while the caudal portion of the right pectoralis muscle is used as a turnover flap at the lower half of the wound. In all 25 patients, the anterior axillary fold was preserved bilaterally and the infection completely resolved. Complications included 3 cases of hematoma, 2 cases of coagulopathy, and 1 late bone sequestrum (aseptic). Although the study had a limited sample size, we had a high rate of success and few complications. With the preservation of bilateral axillary folds, good cosmesis, and adequate wound coverage, we recommend this modification of the pectoralis major flap in even complicated cases of mediastinitis.

A novel robotic surgical technique for thyroid surgery: bilateral axillary approach (BAA).

Bilateral axillo-breast approach (BABA) robotic thyroidectomy (RT) is proven to be a feasible method for the treatment of well-differentiated thyroid cancers in terms of oncology as well as cosmesis. However, BABA RT causes postoperative sternal discomfort and needs an incision over the nipple areolar area. Here, we suggest a novel robotic surgical technique for thyroid surgery that does not need a breast incision-bilateral axillary approach (BAA). We recruited 51 patients who were willing to undergo the novel BAA robotic thyroid surgery. We performed a propensity score-matched analysis to compare the BAA robotic thyroid surgery group (BAA group) with the conventional open thyroid surgery group (open group). Mean operation time in the BAA group (129.7min) was significantly longer than that in the open group (103.1min) (p<0.001). However, no significant differences in the mean number of metastatic lymph nodes (LNs), mean number of retrieved LNs, vocal cord palsy, hypoparathyroidism, and mean stimulated thyroglobulin level were observed between the two groups. There was no case of postoperative bleeding or chyle leak. Of the 51 patients who had undergone the BAA procedure, 27 patients answered the questionnaire. The mean scale, ranging from 0 to 10, at postoperative 1day/2weeks was as follows: voice change score, 3.0/1.6; swallowing difficulty score, 4.0/2.0; anterior neck pain score, 4.6/3.6; anterior neck numbness score, 5.4/4.3; right chest pain score, 3.8/2.1; left chest pain score, 3.6/2.3; right chest numbness score, 3.2/2.8; left chest numbness score, 2.4/2.7; right breast pain score, 0.9/0; left breast pain score, 1.2/0; right breast numbness score, 1.7/0; and left breast numbness score, 2.6/0, respectively. BAA robotic thyroid surgery is a novel, safe, and feasible oncoplastic method, especially for patients who have fear of procedures around the nipple areolar complex.

Large-Sized Bilateral Atherosclerotic Axillary Artery Aneurysms: A Case Report.

Axillary artery aneurysms are most commonly caused by trauma, while atraumatic cases are very rare. Atherosclerosis, collagen tissue diseases, and mycotic infections are additional etiological factors for this type of aneurysms. Once developed, an aneurysm poses risk for hand ischemia or neurologic complications due to embolic events and neural compression. Due to this, diagnosis and treatment of an aneurysm are crucial. We report a case of giant bilateral axillary artery aneurysms developed as a consequence of atherosclerosis.

Synchronous lymphoma and metastatic squamous cell carcinoma in a patient with bilateral abnormal axillary lymph nodes

Synchronous lymphoma and metastatic squamous cell carcinoma in a patient with bilateral abnormal axillary lymph nodes

Retained Textile Foreign Bodies: Experience of 27 Years.

Retained intracorporeal textile products (gossypiboma-textiloma) are undesired and accidental surgical results for both patients and surgeons, which are underreported because of medicolegal remifications. Fourteen textiloma cases, who had been treated or whose treatment procedures had been followed-up personally by two general surgeons in a period of 27 years almost during their whole professional lives were presented to describe and define the clinical and pathological characteristics. Patient characteristics including gender and age, areas of location within the body, time intervals until diagnosis, clinical presentations and complaints, treatment modalities, complications, causative surgical interventions, and diagnostic approaches were retrospectively evaluated. Nine female and five male patients with a mean age of 43.07 ± 15.23 (median: 45) years at diagnosis were enrolled in the study. Cesarean section in three, inguinal hernioraphy in four, explorative laparotomy because of acute abdomen in one, sigmoid colon resection in one, appendectomy and right salpingoophorectomy in one, etrangulated incisional hernia after a previous surgical intervention because of an ovarian mass in one, thyroidectomy in one, epigastric hernioraphy in one, and bilateral segmental mastectomy with bilateral axillary sentinal lymph node dissection in one were the causative surgical interventions. Locations of textilomas were the abdominal cavity in seven, inguinal surgical wound in four, epigastric surgical wound in one, thyroidectomy lodge in one, and bilateral axillary cavities in one patient. The mean time interval until diagnosis was 14.48 (median: 5.5) months. Earlier recognition of foreign bodies can provide a better outcome. Gossypibomas are preventable iatrogenic faults which create severe problems. Strict adherence to the rules of the operation room is a must to keep the tip of the iceberg shut in the Pandora's box.

Bilateral brachial plexus block. Case reporting and systematic review of literature

Abstract Background The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure. Clinical cases Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity. A systematic review of the literature from January 1993 to June 2013, was also performed by using a search in the MEDLINE, EMBASE, ARTEMISA, LILACS, Google data bases, in Spanish and English language with the following words: bilateral brachial plexus block, bilateral interscalene block, bilateral infraclavicular block, bilateral supraclavicular block, bilateral lateral supraclavicular block, bilateral axillary block, ultrasound-guided bilateral brachial plexus block. Conclusion Based on the evidence found, ultrasound-guided bilateral brachial plexus block in selected patients and expert hands, is no longer a contraindication.

A rare presentation of intrapericardial hematoma 20 months post aortic valve replacement

We report the successful treatment of a rare case of chronic intrapericardial hematoma which presented with congestive cardiac failure 20 months after aortic valve replacement surgery for severe calcific aortic stenosis. Chest roentgenograph demonstrated paracardiac mass over lower left ventricle border, left pleural effusion and pulmonary venous hypertension. An echocardiographic study demonstrated intrapericardial mass posterolateral to left ventricle compressing left ventricular cavity both during systole and diastole causing septum to bulge into right ventricle. Computed tomography showed a loculated pericardial mass in left heart margin, left pleural effusion, bilateral axillary and mediastinal lymphadenopathy. Surgical resection was planned to relieve the symptoms and to confirm the diagnosis of the mass. The mass was completely resected through left anterolateral thoracotomy and histopathology findings confirmed the diagnosis of hematoma with cystic degeneration. Postoperative course was uneventful, and his symptoms improved markedly.

Bilateral aberrant axillary breasts in puerperium

Ectopic breast tissue (EBT) is rare with a reported incidence of 0.4-6% worldwide, the commonest site being the axilla. It results from incomplete regression of the embryonic mammary ridges that extend bilaterally from the axillae to the groins, and may be associated with other clinical syndromes. EBT comprises accessory breasts, in which there is an accessory nipple, areola, or both, with or without glandular tissue, and aberrant breast tissue, in which the ectopic glandular tissue is without a nipple or areola. Aberrant breast tissue may remain asymptomatic until menarche, pregnancy, or lactation, when it responds to hormonal fluctuation. Diagnosis is important as EBT is subject to all pathologies of the normal breast, including cancer. We present the case of a 38-year-old multipara with bilateral aberrant axillary breasts noted only during her last pregnancy who had excision of the masses in the puerperium.

术前栓塞鼻咽纤维血管瘤的疗效分析

目的：探讨术前栓塞鼻咽部纤维血管瘤供血动脉的临床疗效。方法：采用Seldinger技术，超选择插管对肿瘤颈外供血动脉进行栓塞后1~3 d内手术切除。结果：12例患者，患侧颌内动脉供血9例，合并咽升动脉供血1例。双侧颌内动脉分支供血2例，患侧颌内动脉及颈内动脉分支供血1例；均未发生严重并发症；栓塞后11例完整手术切除，1例部分切除拟分期手术。术中平均出血约380 ml。结论：术前血管栓塞鼻咽部血管瘤可有效减少术中出血，并增加肿瘤切除率。 Objective: To investigate the clinical efficacy of pre-surgical embolization of nasopharyngeal angiofibroma. Methods: Using Seldinger technique, 12 cases with nasopharyngeal angiofibroma underwent superselective feeding arteries emboilization, and then 1 - 3 days later, the angiofibroma was cut. The intraoperative blood loss was recorded. Results: For the 12 cases, 9 cases of nasopharyngeal angiofibroma were supplied by single-side internal maxillary artery, and 1 case combined with ascending pharyngeal artery, the bilateral internal axillary artery was in 2 patients, and the same lateral axillary artery and the branches of the internal carotid artery was in 1 patient. No serious complication happened after embolization. After thrombosis, in 11 cases underwent complete surgical resection, 1 case was of resection to staging surgery. All lesions were radical removed. The average intraoperative blood loss was 380 ml. Conclusion: The pre-surgical embolization of nasopharyngeal angiofibroma can reduce the intraoperative blood loss and increase radical resected rate.

68Ga DOTANOC PET/CT in Primary Neuroendocrine Tumor of the Breast

Primary neuroendocrine tumor (NET) of the breast is very rare. We present a case of a pathologically confirmed, primary breast NET in a 49-year-old woman with 68Ga DOTANOC PET/CT imaging findings. 68Ga DOTANOC PET/CT revealed somatostatin receptors expressing active lesions in primary right breast NET with metastases to multiple bilateral axillary and right cervical lymph nodes, bilateral lungs, and multiple skeletal sites.

Bilateral pseudoangiomatous stromal hyperplasia tumors in axillary male gynecomastia: report of a case

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign proliferation of breast stromal cells with a complex pattern of interanastomosing spaces lined by myofibroblasts. The exact etiology is still unknown, but a proliferative response of myofibroblasts to hormonal stimuli has been postulated. PASH is a relatively common incidental finding in breast tissue removed for other reasons and rarely manifests as a localized mass. Fewer than 150 cases of tumoral PASH have been reported since it was first described in 1986. Although PASH tends to grow over time, most lesions are cured by surgical excision and the prognosis is excellent. We report an unusual case of bilateral axillary tumoral PASH in a 44-year-old man. Awareness of this disease is important when considering the differential diagnosis of axillary masses. To our knowledge, only one other case of unilateral axillary tumoral PASH in a male patient has been described in English and this is the first case of PASH occurring in male bilateral axillary gynecomastia.

A rare case of non-invasive ductal carcinoma of the breast coexisting with follicular lymphoma: A case report with a review of the literature

The double presentation of breast cancer and follicular lymphoma is extremely rare, and only six cases have previously been reported in the literature. In the present study, a case of synchronous ductal carcinoma in situ (DCIS) of the breast and follicular lymphoma is reported. During an annual breast screening procedure, a 49-year-old female presented with a hard induration under the nipple of the right breast and swelling of a soft lymph node (LN) in the right axilla. Mammography and ultrasonography revealed two lesions in the right breast: One was a tumor with microcalcification, 1.0 cm in diameter, and the other was a large, crude calcification, 2.5 cm in diameter. In addition, computed tomography and positron emission tomography revealed swellings of the bilateral axillary (Ax) LN and intra-abdominal para-aortic LN. The patient underwent excisions of the large calcified mass, a micro-calcified tumor and the right AxLN. The pathological and immunohistochemical studies revealed fat necrosis and DCIS of the breast, which was positive for the estrogen receptor and the progesterone receptor, while human epidermal growth factor receptor II protein expression was evaluated as 2+ and stage was classified as pTis pN0 M0, stage 0. Furthermore, the Ax node was diagnosed as follicular lymphoma, which was positive for cluster of differentiation (CD)20, CD79a, CD10 and B-cell lymphoma (Bcl)-2 protein, but negative for Bcl-6 protein. The clinical stage was classified as stage III. The patient was administered chemotherapy followed by radiotherapy to the conserved breast. Two years have passed since the surgery, and the patient is disease-free.

Advanced Papillary Carcinoma of the Breast Presenting as an Ulcerated Anterior Chest Wall Tumour: Case Report

BACKGROUND: Papillary carcinoma of the breast is a rare malignant tumour accounting for 1% - 2% of all breast cancers in women. Papillary carcinomas of the chest wall are always secondary to thyroid, thymus and ovaries. Other variants of breast cancer metastasizing to the chest wall have been reported. CASE: We report a 67-year-old woman presented to us with an ulcerated anterior chest wall mass of 1-year duration, bilateral axillary, supraclavicular and cervical swellings of 8-month duration. There was a history of breast lump which was noticed 5 years prior to presentation, no history of breast malignancy in the past and no family history of breast cancer. Examination revealed an ulcerated, nodular mass over the sternal angle which measured 14 cm × 12 cm × 4 cm; she had bilateral axillary, supraclavicular and cervical lymphadenopathy which were non-tender and matted. She had a firm, non-tender right breast lump measuring 6 cm × 4 cm. Chest examination and abdominal examinations were essentially normal. Chest X-ray revealed erosion of sternal bone without any evidence of intrathoracic extension. Abdominal ultrasound and thyroid scans were normal. Histology of the mass revealed papillary carcinoma. Biopsy of the right breast also revealed papillary carcinoma. She had excision of the fungating tumour and primary closure of defect. She subsequently had combination chemotherapy using ondasetron, cyclophosphamide, adriamycin and cisplantin. CONCLUSION: Papillary carcinoma of the breast is rare and rarely metastasizes to the chest wall. The diagnosis of metastatic chest wall tumour requires meticulous history taking, clinical examination and relevant investigations to ascertain the primary origin of the carcinoma.

Atypical Presentation of High-Grade Intramedullary Osteosarcoma with Bilateral Cervical, Supraclavicular, and Axillary Lymphadenopathy: A Case Report and Literature Review

Osteosarcoma typically presents with primary site pain. The authors report a case of extensive metastatic osteosarcoma without any complaint of primary site pain during initial presentation. The 23-year-old female patient presented with simultaneous multiple cervical, supraclavicular, and axillary lymphadenopathy, as well as two large subcutaneous fat tumours. Despite initial excision biopsy of cervical lymph nodes, the diagnosis of osteosarcoma was only clinched after open biopsy of the right distal femur lesions and further histological evaluation. Though the patient was promptly started on neo-adjuvant chemotherapy and achieved excellent histological response to treatment, the disease had relapsed quickly and she succumbed to the disease one year after initial presentation. This report highlights the need to be vigilant in the workup and investigation of osteosarcoma, as the presenting symptoms may be more heterogenous than the conventional teaching of primary site pain.

Advanced papillary carcinoma of the breast presenting as an ulcerated anterior chest wall tumour: case report

BACKGROUND: Papillary carcinoma of the breast is a rare malignant tumour accounting for 1% - 2% of all breast cancers in women. Papillary carcinomas of the chest wall are always secondary to thyroid, thymus and ovaries. Other variants of breast cancer metastasizing to the chest wall have been reported. CASE: We report a 67-year-old woman presented to us with an ulcerated anterior chest wall mass of 1-year duration, bilateral axillary, supraclavicular and cervical swellings of 8-month duration. There was a history of breast lump which was noticed 5 years prior to presentation, no history of breast malignancy in the past and no family history of breast cancer. Examination revealed an ulcerated, nodular mass over the sternal angle which measured 14 cm × 12 cm × 4 cm; she had bilateral axillary, supraclavicular and cervical lymphadenopathy which were non-tender and matted. She had a firm, non-tender right breast lump measuring 6 cm × 4 cm. Chest examination and abdominal examinations were essentially normal. Chest X-ray revealed erosion of sternal bone without any evidence of intrathoracic extension. Abdominal ultrasound and thyroid scans were normal. Histology of the mass revealed papillary carcinoma. Biopsy of the right breast also revealed papillary carcinoma. She had excision of the fungating tumour and primary closure of defect. She subsequently had combination chemotherapy using ondasetron, cyclophosphamide, adriamycin and cisplantin. CONCLUSION: Papillary carcinoma of the breast is rare and rarely metastasizes to the chest wall. The diagnosis of metastatic chest wall tumour requires meticulous history taking, clinical examination and relevant investigations to ascertain the primary origin of the carcinoma.

A Rare Case of Rosai-Dorfman Disease in an Adult Male Associated with Auto-immune Hemolytic Anemia.

Rosai-Dorfman disease (RDD) is a rare benign histiocytic proliferative disorder predominantly of the lymph nodes, which mostly occurs in children and young adults typically presenting with lymphadenopathy. Our case is of a 63 year-old African-American male who presented with subjective fever, weight loss, bilateral axillary and inguinal lymphadenopathy as well as auto-immune hemolytic anemia. The histological analysis showed emperipolesis and histiocytes that were positive for S-100 and CD-68 consistent with RDD. After steroid treatment and splenectomy, patient’s symptoms and hemolytic anemia had resolved. Our case is the first case of RDD reported to be associated with auto-immune hemolytic anemia in an adult.

Is Screening Detected Bilateral Axillary Adenopathy on Mammography Clinically Significant?

Our objective was to retrospectively review the incidence and outcome of asymptomatic patients recalled from screening due to bilateral axillary adenopathy (BAxA) with an otherwise normal mammogram. This study included all women recalled from screening due to BAxA that underwent ultrasound guided biopsy between July 2004 and April 2010. Women with a known etiology for adenopathy were excluded. One radiologist blinded to biopsy outcome evaluated mammographic lymph node characteristics. Twelve of 74,926 screening mammograms (0.016%) performed during the study period met inclusion criteria. Five women (41.7%) had non-Hodgkin lymphoma (NHL); two had long axis dimension of <20 mm, but had prior mammograms demonstrating an increase in size and density of the lymph nodes. There were no significant differences in lymph node characteristics between benign and malignant results. This study finds a high positive predictive value for malignancy for BAxA when no etiology is apparent. We propose that patients with BAxA as the sole mammographic abnormality undergo further imaging and clinical evaluation as this may indicate significant pathology.

Robotic Thyroidectomy: Must We Drive a Luxury Sedan to Arrive at Our Destination Safely?

Robotic Thyroidectomy: Must We Drive a Luxury Sedan to Arrive at Our Destination Safely?

FDG PET/CT in Diagnosing and Staging Cutaneous Eccrine Adenocarcinoma

Cutaneous eccrine adenocarcinoma is a rare skin cancer. We reported a case of an 86-year-old woman with a nail-size papule on her back for 40 years, which became enlarged in the past 2 months. Physical examination revealed right axillary lymphadenopathy. FDG PET/CT scan showed intense FDG activity in the primary back lesion and bilateral axillary nodes. The histopathologic results after tumor resection and bilateral axillary lymph node dissection indicated cutaneous eccrine adenocarcinoma with metastases in axillary nodes.