Summary
During left nephrectomy in a 35-year-old woman with a left renal cell carcinoma extending into the inferior vena cava (IVC) and right atrium, cardiac arrest occurred. Immediate transesophageal echocardiography demonstrated that the event was caused by a pulmonary tumor embolism. Emergent cardiopulmonary bypass (CPB) was established and the tumors in the pulmonary arteries were successfully removed. The left nephrectomy was completed. The patient recovered in the intensive care unit without any neurological deficit. A postoperative pulmonary perfusion scintigram showed no defect in the pulmonary circulation. Transesophageal echocardiography was useful for making a rapid diagnosis of an intraoperative pulmonary embolism originating from a tumor of the IVC or right atrium.
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References
Marshall FF, Rietz BA (1986) Technique for removal of renal cell carcinoma with suprahepatic vena caval tumor thrombus. Urol Clin North Am 13:551–557
Langenburg SE, Blackbourne LH, Sperlin JW, Buchman SA, Mauney MC, Kron IL, Tribble CG (1994) Management of renal tumors involving the inferior vena cava. J Vasc Surg 20:385–388
Utley JR, Mobin-Uddin K, Segnitz RH, Belin RP, Utley RU (1973) Acute obstruction of tricuspid valve by Wilms’ tumor. J Thorac Cardiovasc Surg 66:626–628
Daughtry JD, Stewart BH, Golding LAR, Groves LK (1977) Pulmonary embolus presenting as the initial manifestation of renal cell carcinoma. Ann Thorac Surg 24:178–181
Akyon MG, Arslan G (1981) Pulmonary embolism during surgery for a Wilms’ tumor (nephroblastoma). Br J Anaesth 53:903–905
Milne B, Cervenko FW, Morales A, Salerno TA (1981) Massive intraoperative pulmonary tumor embolus from renal cell carcinoma. Anesthesiology 54:253–255
Wilkinson CJ, Kimovec MA, Uejima T (1986) Cardiopulmonary bypass in patients with malignant renal neoplasms. Br J Anaesth 58:461–465
Fukui K, Narita J, Takahashi S, Ono Y, Takeuchi I, Iwabuchi T, Shudo K, Sawada M, Nomura S, Suzuki S, Koie H, Takashima T (1992) A case report of massive pulmonary tumor embolism that occurred during surgery for renal cell carcinoma (in Japanese). Kyobu Geka (6) 45:529–532
Arkless R (1965) Renal carcinoma: How it metastasizes. Radiology 84:496–501
Hedderich GS, O’Connor RJ, Reid EC, Mulder DS (1987) Caval tumor thrombus complicating renal cell carcinoma: A surgical challenge. Surgery 102:614–621
Rosenthal D, Gershon CR, Rudderman R (1985) Renal cell carcinoma invading the inferior vena cava: The use of the Greenfield filter to prevent tumor emboli during nephrectomy. J Urol 134:126–127
Nixdorff U, Erbel R, Drexler M, Meyer J (1988) Detection of thromboembolus of the right pulmonary artery by transesophageal two-dimensinal echocardiography. Am J Cardiol 15:488–489
Katz ES, Rosenzweig BP, Rorman D, Kronzon I (1992) Diagnosis of tumor embolus to the pulmonary artery by transesophageal echocardiography. J Am Soc Echocardiogr 5:439–443
Langeron O, Goarin JP, Pansard JL, Riou B, Viars P (1992) Massive intraoperative pulmonary embolism: Diagnosis with transesophageal two-dimensional echocardiography. Anesth Analg 74:148–150
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Nagasaka, S., Taniguchi, S., Kobayashi, S. et al. Successful treatment of intraoperative pulmonarytumor embolism from renal cell carcinoma. Heart Vessels 12, 199–202 (1997). https://doi.org/10.1007/BF02767048
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DOI: https://doi.org/10.1007/BF02767048