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Case Reports
. 2017 Jul;99(6):e162-e164.
doi: 10.1308/rcsann.2017.0073.

Major haemorrhage requiring transarterial embolisation following open biopsy of an unusual neck mass

M Walsh  1 , M Supriya  1 , N Railton  1
Affiliations
Case Reports

Major haemorrhage requiring transarterial embolisation following open biopsy of an unusual neck mass

M Walsh et al. Ann R Coll Surg Engl. 2017 Jul.

Abstract

A 65-year-old man presented with a right supraclavicular neck mass and right arm pain. Magnetic resonance imaging revealed a 96mm lesion in the upper thoracic paraspinal region extending into the deep supraclavicular fossa. The presentation was consistent with a sarcoma or lymphoma but fine needle aspiration was inconclusive. During open biopsy of the lesion, the patient had a rapid intraoperative haemorrhage of 1l from the tumour. Haemostasis could only be achieved by transarterial embolisation of the feeding vessel and the biopsy result confirmed Ewing's sarcoma. Open biopsy is considered the gold standard in the diagnosis of certain tumour types; however, the morbidity from haemorrhage must be considered. This case highlights the key role that transarterial embolisation can play in achieving haemostasis in the neck.

Keywords: Embolisation; Ewing’s; Haemorrhage; Neck mass; Sarcoma.

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Figures

Figure 1
Figure 1
Coronal T1 weighted post-contrast magnetic resonance imaging showing the enhancing mass extending from the right upper paraspinal region through the first intercostal space into the deep supraclavicular fossa
Figure 2
Figure 2
Coronal multiplanar reformatted (maximum intensity projection) computed tomography angiography showing surgical packing material in the tumour cavity and the principal arterial inflow from the dorsal scapula artery
Figure 3
Figure 3
Selective digital subtraction angiography of the dorsal scapula artery demonstrating the arterialisation of the tumour and enhancement of the hypervascular tumour parenchyma
Figure 4
Figure 4
Fluoroscopy showing microcoils in the individual arterial branches on completion of embolisation
See this image and copyright information in PMC

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