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Case Reports in Anesthesiology
Volume 2016 (2016), Article ID 2106242, 4 pages
http://dx.doi.org/10.1155/2016/2106242
Case Report

Complex Perioperative Decision-Making: Liver Resection in a Patient with Extensive Superior Vena Cava/Right Atrial Thrombus and Superior Vena Cava Syndrome

1Department of Anesthesia, Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
2Department of Anesthesia, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA

Received 14 November 2015; Revised 5 January 2016; Accepted 6 January 2016

Academic Editor: Jian-jun Yang

Copyright © 2016 Benjamin Kloesel and Robert W. Lekowski. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The perioperative management of patients suffering from extensive superior vena cava (SVC) thrombus complicated by SVC syndrome presents unique challenges. The anesthesiologist needs to be prepared for possible thrombus dislodgement resulting in pulmonary embolism and also has to assess the need for fluid resuscitation given the dangers of massive intravenous fluid application via the upper extremities. We present our perioperative approach in management of a patient scheduled for right hepatectomy who was previously diagnosed with extensive SVC and right atrial (RA) thrombus complicated by SVC syndrome.