Case of the “spare heart” tumour
Case of the “spare heart” tumour. Teamwork carries the day.
Sometimes, neurosurgeons end up in unexpected circumstances! This lady presented with a large mass (boxes 1 & 2, red circle, in the collage below) behind her left lung and abutting her aorta and spine (box 1, yellow circle). The interventional radiologist put spinal markers in to help guide me to T7 and T8 (box 2). The anesthetist intubated her with a double-lumen tube (box 3) and intentionally deflated her left lung (box 5) so the cardiothoracic surgeons (box 4) could get their endoscope in to start with. The neurosurgeon could then do his bit (explore and clear the left paraspinal gutter in the lateral decubitus spinal position) before the cardiothoracic team completed their tumour resection via thoracotomy. The grapefruit-size tumour (box 6), which to me looked like a ‘spare heart’, was removed uneventfully. The patient’s happy in the care of the ICU team, so the operating team’s happy too (box 7). We’ll wait and see what the tissue diagnosis of this rare tumour ends up being. Thanks Mr Marco Larobina, Dr Praveen Vats, Dr Anthony Felber, & Epworth Richmond theatre nursing.
