Figure 2

Case 1 – (A, B) Doppler US scan of poorly differentiated extensive papillary thyroid carcinoma at the level of the supra-sternal notch. (A) US scan Using a craniopodal orientation of the "endocavitary probe", the shape of this "specific probe" used here allows for visualization of compressed left inominate vein (v) by the tumor and malignant nodes at level VII. (B) (same patient, same area of interest). Color Doppler assessment of left inominate vein shows persistent respiratory phasicity and cardiac rythmicity. This indicates patency of the inominate vein and SVC [5]. (C) Axial Color Doppler in the left neck in a T4b thyroid cancer patient shows left common carotid artery (LCA) encasement by the aggressive tumor. A 360° encasement was a local contraindication to local surgery at that time, at our institution. The concept of "shave resection" was established a few years later. (D) Longitudinal Doppler US scan shows a typical waveform identifying tumoral stenosis of LCA. Left IJV was compressed by tumor. Right SCV Doppler assessment showed normal Doppler waveforms. Thus, central venous compression was localized to the left side of the neck and upper mediastinum without thrombosis of the SVC [5].