Shoulder; Tikhoff-Linberg
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- Mabel Carpenter
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1 71 yo, 1st referral:july 8, 2013 HPI: Increasing pain of right shoulder Especially pain at night No improvement with physiotherapy PMH: Dyslipidemia WITNESS JEHOVAH!!! ( absolutely no blood/products at all!)
2 axillary nerve? intra- / transarticular? level of OT & abductor?
3 Clinical findings: Slightly decreased shoulder ROM (flexion), otherwise symmetrical Jobe-Test painful, positive lift-off
4 MRI April 12th 2013 PDW SPIR + KM
5 MRI April 12th 2013 PDW SPAIR+KM PDW SPIR + KM
6 MRI April 19th 2013 SSP clavicle SSP ISP acromion glenoid ISP PDW atse T1 SPIR KM SupraSPinatus, InfraSPinatus
7 CT Chest July 18, 2013 no evidence of metastasis
8 Biopsy July 18th 2013
9 Biopsy July 18th 2013
10
11
12
13 CD34 Shoulder; Tikhoff-Linberg
14 Proliferationsfraktion (mib1) bis 40%
15 Result Biopsy, July 18, 2013
16 MRI right shoulder, July 25, 2013 July April T1_fs_KM T1_fs_KM T1_fs_KM T1_KM T1_KM T1_KM
17 MRI right shoulder, July 25, 2013 T1_fs_KM tirm
18 Sarcoma Board: July 25, 2013 Therapeutic decisions: Radiotherapy: Yes, preoperative RT Chemotherapy: no Surgery: Surgery is carried out after completion of RT
19 preoperative Radiotherapy Planning 2013
20 preoperative Radiotherapy Planning 2013
21 Clinical presentation October 2nd 2013
22 MRI right shoulder, October 03, 2013 July October T1_fs_KM T1_fs_KM T1_fs_KM T1_fs_KM T1_fs_KM T1_fs_KM
23 MRI right shoulder, October 03, 2013 T1_fs_KM tirm
24 MRI October 3rd 2013 Relation to neurovascular bundle 19mm Tumor Plexus brachialis V. axillaris A. axillaris Tumor T2_tse T1_tse
25 CT Chest October 3rd 2013 no evidence of metastasis
26 surgical options Tikhoff-Linberg procedure Forequarter Amputation with/without partial resection of the chest wall
27 preoperativ picture: November 18, 2013
28 Surgery November 22, 2013
29 Surgery November 22, 2013
30 Surgery November 22, 2013
31 Surgery November 22, 2013 Biceps, long head Point of coracoid with Conjoined tendon Plexus Clavicula Deltoideus Humerus Ribs Axillary nerve Scapula, Angulus inferior Rhomboidei
32 Surgery November 22, 2013 Clavicula Humeral head Scapula
33 Surgery November 22, 2013 Biceps Humerus Conjoined tendon Scapula Clavicula Ribs: Fixation at thorax Rhomboidei
34 Surgery November 22, 2013 Rhomboidei
35 Surgery November 22, 2013
36 Surgery November 22, 2013
37 Surgery November 22, 2013
38 Result Surgery November 22, 2013
39 Result Surgery November 22, 2013
40
41
42 Result Surgery November 22, 2013
43 Sarcoma Board: November 28, 2013 Therapeutic decisions: The patient is still stationary, but after hospital discharge the patient will be planned for a postoperative follow-up by the appropriate discipline (depending on the def. Pathology results).
44 clinical pics: 12 December, 2013
45 RX Shoulder: January 09th, 2014
46 MRI Shoulder: February 21th, 2014 no evidence of recurrence
47 CT-Thorax: February 22th, 2014 no suspect lesions
48 clinical visit: May 15th, 2014
49 clinical visit: May 15th, 2014
50 MRI Shoulder: May 15th, 2014 No evidence of recurrence
51 CT-Thorax: May 15th, 2014
52 Sarcoma Board: May 22th, 2014 Therapeutic decisions: Chemotherapy: no. Radiotherapy: no. Hyprosar: no. Surgery: Dr. Schneiter thoracic surgery USZ informed the Board that the left metastasis suspicious lesion can be removed minimally invasively to obtain a definitive diagnosis. A following CT thorax should be made to see if the right lesion size remains constant and if there are other lesions. Depending on the evaluation of the CT, the right lesion can then also subsequently be removed.
53 Thoracic Surgery June 2014
54 CT Chest Nov 2014 vs. Feb 2015 Nov 11th 2014 Feb 25th 2015
55 CT Chest May 27th 2015 metastasis aortic arch metastasis
56 Clinical presentation May 27th 2015
57 Clinical presentation May 27th 2015
58 May 28, 2015
59
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