An intermittent ascending aorta clamping strategy to rescue an emergency management of unexpected massive hemorrhage in mediastinal tumor surgery: a case report

Figures

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  Fig. 1. Mediastinal CT view. Mediastinal coronal and axial CT demonstrates a large soft tissue mass, measuring approximately 8.4 × 7.4 cm, located within the retrosternal great vessel space and extending from the thoracic inlet to the level of the pericardium. The lesion exhibits heterogeneous internal density and shows heterogeneous enhancement after contrast administration. There is obliteration of the fat planes between the mass and the adjacent local tissues. The lesion abuts and displaces the intrathoracic great vessels and compresses part of the left thoracic cavity. Aortic arch branches: right brachiocephalic trunk; left common carotid artery; left subclavian artery

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  Fig. 2. Preliminary clamp placement before identifying the site of injury

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  Fig. 3. Definitive clamp placement after localizing the injured site

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  Fig. 4. Vascular repair with native heart perfusion and distal circulatory support. (Figures 2, 3 and 4: Schematic diagram for illustrative purposes only, depicting the intraoperative clamping strategy and cardiopulmonary bypass.)

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  Fig. 5. Postoperative Cranial CT Scan. Postoperative head CT scan shows: scattered hypodense lesions in the bilateral centrum semiovale and periventricular regions, possibly representing cerebral edema. No obvious midline shift, ischemic or infarction lesions are seen in the brain parenchyma