Accurate detection of pulmonary embolism using epicardial echocardiography during right nephrectomy in a patient with renal cell carcinoma

Tsubo, Toshihito; Ebina, Masako; Otomo, Noriaki; Ishihara, Hironori; Matsuki, Akitomo

doi:10.1016/s1053-0770(98)90244-0

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…8 Pulmonary arterial tumor embolism is rare in patients with renal carcinoma, and most cases in the literature represent intraoperative tumor embolism during mobilization and removal of primary tumor. 5,6,9,10 Preoperative diagnosis of pulmonary tumor embolism in renal cell carcinoma with subsequent surgical treatment has been reported in only 3 cases in the English literature. [11][12][13] Therefore, the optimal treatment strategy in these patients and the impact of concomitant pulmonary arterial tumor removal on prognosis are unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Most cases in the literature arise from intraoperative pulmonary embolization of tumor during resection requiring emergency pulmonary tumor removal as a lifesaving procedure, and only a limited number of patients have survived. 5,6 We report our experience with concomitant pulmonary arterial tumor removal with radical nephrectomy in patients with renal neoplasms.…”

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confidence: 99%

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Concomitant surgery for renal neoplasm with pulmonary tumor embolism

Kayalar

Leibovich

Orszulak

et al. 2010

The Journal of Thoracic and Cardiovascular Surgery

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Pulmonary artery embolic tumor removal concomitant with nephrectomy for renal carcinoma can be performed safely. Survival of patients with combined surgery is comparable with that of patients with the same stage of renal neoplasm without pulmonary tumor embolism. The pulmonary tumor embolism in patients with renal carcinoma should be considered as extension of vena caval tumor but not as a distant metastasis. Pulmonary tumor removal provides symptomatic relief and may provide a survival benefit in these patients.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Concomitant surgery for renal neoplasm with pulmonary tumor embolism

Kayalar

Leibovich

Orszulak

et al. 2010

The Journal of Thoracic and Cardiovascular Surgery

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“…The literature shows that tumour thromboembolism into the pulmonary artery is rare for RCC and usually occurs during cava manipulation and mobilization, 4,7,8 or is detected preoperatively when a patient has pulmonary symptoms and chest imaging reveals the finding. 9 To our knowledge, we are the first to present a case of RCC with cava tumour thrombus in which the pulmonary artery tumour thromboembolism was detected in such a manner, incidentally on TEE.…”

Section: Discussionmentioning

confidence: 99%

“…2 Most cases arise from preoperative findings on chest imaging (for a symptomatic patient) or from intraoperative embolization during caval manipulation leading to emergency chest surgery to remove the tumour embolus. 3,4 We report a case of a renal neoplasm with caval tumour thrombus with an unanticipated finding of pulmonary tumour thromboembolism found on routine intraoperative transesophageal ultrasound.…”

Section: Introductionmentioning

confidence: 97%

Unanticipated intra-operative finding of pulmonary artery tumour thromboembolism during radical nephrectomy and caval thrombectomy: Case report and management

Sharda

Deutscher

Christodoulou

et al. 2013

CUAJ

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We report a case of an unanticipated intra-operative transesophageal echocardiography (TEE) finding of pulmonary artery thromboembolism in a 72-year-old woman being prepared for radical nephrectomy and caval thrombectomy. Upon intra-operative TEE to evaluate the extent of caval thrombus, we found a pulmonary artery tumour thromboembolism in an otherwise asymptomatic patient after induction and prior to surgery. A chest computed tomography confirmed a large saddle tumour thromboembolus. A multidisciplinary approach was used to facilitate radical nephrectomy with caval thrombectomy and pulmonary artery thromboembolectomy. This case shows the importance of adequate perioperative imaging and use of intra-operative TEE to evaluate the extent of disease. To our knowledge, we are the first to present a case of RCC with cava tumour thrombus in which the pulmonary artery tumour thromboembolism was detected incidentally on intraoperative TEE.

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“…4,7,21 Importantly, the absence of RV dysfunction effectively eliminates massive PE as a cause of cardiovascular instability, and requires pursuit of an alternative diagnosis. 4 Epicardial imaging has also been suggested as an additional tool for PE-visualization, 22 but is clearly applicable only to open chest procedures. Therefore, imaging techniques such as CE-TEE that improve the diagnostic capabilities of intraoperative TEE are invaluable.…”

Section: Discussionmentioning

confidence: 99%

Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography

Izrailtyan

Clark

Swaminathan

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Perioperative pulmonary embolism (PE) is associated with significant morbidity and mortality. Intraoperatively, the clinical management of patients with PE can be enhanced by the use of transesophageal echocardiography (TEE) to visualize emboli, assess pulmonary artery (PA) anatomy, and monitor the function of the right ventricle. However, the sensitivity of intraoperative TEE to detect thromboemboli is reported to be below 50%. In this report, we describe the use of contrastenhanced TEE (CE-TEE) to improve the visualization of PE. Clinical features:A 44-yr-old female with chronic thromboembolic pulmonary hypertension was scheduled for pulmonary thromboendarterectomy. The precardiopulmonary bypass TEE exam demonstrated signs of PA obstruction and right ventricle dysfunction, but the borders of the thrombus in the right PA were only minimally visualized. Perflutren lipid microspheres, composed of octafluoropropane encapsulated in an outer lipid shell, were injected as a 0.3 mL iv bolus, while visualizing the right PA with harmonic ultrasound imaging. The CE-TEE image clearly visualized a large mobile thrombus along with a distinct pattern consistent with pulmonary flow obstruction. The postcardiopulmonary bypass CE-TEE confirmed thrombus evacuation and absence of PA flow abnormalities. Conclusion:Contrast-enhanced-TEE may decrease operator dependency and increase the sensitivity necessary to detect central, surgically accessible PE.

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Accurate detection of pulmonary embolism using epicardial echocardiography during right nephrectomy in a patient with renal cell carcinoma

Cited by 5 publications

References 7 publications

Concomitant surgery for renal neoplasm with pulmonary tumor embolism

Concomitant surgery for renal neoplasm with pulmonary tumor embolism

Unanticipated intra-operative finding of pulmonary artery tumour thromboembolism during radical nephrectomy and caval thrombectomy: Case report and management

Case report: Optimizing intraoperative detection of pulmonary embolism using contrast-enhanced echocardiography

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