Massive Intraoperative Pulmonary Embolus Diagnosed by Transesophageal Echocardiography

Wilson, William C.; Frankville, David D.; Maxwell, William; Carpenter, Timothy S.; Hastings, Randolph H.

doi:10.1097/00000542-199408000-00030

Cited by 19 publications

(14 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Unlike the results with thrombolysis, uncontrolled hemorrhage is unlikely after heparinization, because disruption of the intrinsic coagulation cascade does not perturb the clot previously formed at the site of surgery [15,16]. In our patient, considering the absence of large emboli in the PA trunk, we directed our therapeutic approach towards heparin administration, combined with hemodynamic support [15].…”

Section: Discussionmentioning

confidence: 99%

Unexpected complication of massive intraoperative pulmonary embolism following elective sigmoidectomy in the supine position

et al. 2008

View full text Add to dashboard Cite

We describe a case of massive intraoperative pulmonary thromboembolism during elective sigmoidectomy in the supine position. During recovery from anesthesia, the patient developed hemodynamic compromise and severe hypoxemia. Intravenous inotropes and mechanical ventilation were instituted. The abrupt onset of symptoms and the pulmonary artery catheter, chest radiograph, and transesophageal echocardiography findings suggested massive pulmonary thromboembolism as a possible cause of the hemodynamic compromise and hypoxemia. Emergent angiography could not be carried out due to the patient's poor clinical status. Lack of experience in performing embolectomy, along with contraindication for thrombolysis, imposed the use of intravenous heparin and hemodynamic support as the only appropriate therapeutic modality. After 2 days' aggressive hemodynamic and ventilatory support, the patient had an uneventful course, and was discharged from the intensive care unit (ICU) 14 days later.

show abstract

Section: Discussionmentioning

confidence: 99%

Unexpected complication of massive intraoperative pulmonary embolism following elective sigmoidectomy in the supine position

et al. 2008

View full text Add to dashboard Cite

show abstract

“…By way of diagnosing PTE, noninvasive and invasive techniques have been used with varying success [1][2][3][4][5][6][7][8][9][10][11][12]. Examples of the former include serologic assay (eg, d-dimer), and radiographic tests (eg, chest radiography, spiral computed tomography, ventilation-perfusion scan, magnetic resonance angiography, and echocardiography).…”

Section: Discussionmentioning

confidence: 99%

“…Although pulmonary angiography remains the invasive bgold standardQ diagnostic technique [3,7] (detecting emboli as small as 1 mm), its applicability in the OR is limited. As a result of its portability, image quality, sensitivity (80%), specificity (100%), and buser friendliness,Q TEE may supplant angiography as the diagnostic modality of choice in the OR [1,5,7,9,11,12]. In addition to its diagnostic capability, TEE also aids the clinician with risk stratification and prognostication [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Treatment typically depends on the clinical presentation. For example, hemodynamically stable patients may be approached with less aggressive measures such as IVC filter placement with or without systemic anticoagulation (eg, heparin followed by Coumadin maintenance) [3,7,11]. On the other hand, hemodynamically unstable patients require more aggressive definitive therapy such as pulmonary embolectomy (via transvenous catheter or CPBfacilitated surgery), or systemic or central chemical thrombolysis [1][2][3][4][5][6][7]9,10].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular collapse during elective orthopedic surgery: massive intraoperative pulmonary thromboembolism treated with emergent cardiopulmonary bypass

Obray

Long

Rehfeldt

et al. 2005

Journal of Clinical Anesthesia

View full text Add to dashboard Cite

“…11 Emboli made of particulate matter, on the other hand, are often detectable by TEE for much longer periods of time after an incident. 12,13 The postoperative pulmonary edema of the patient is also suggestive of a gas embolism. 14 In summary, laparoscopic donor nephrectomies though usually performed on healthy individuals, have their pitfalls, and complications during this procedure can be sudden and serious.…”

Section: Objectif : Présenter Le Cas D'une Néphrectomie Laparoscopiqumentioning

confidence: 99%

Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report

Martay

Dembo

Vater

et al. 2003

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

P Pu ur rp po os se e: : To report the case of a laparoscopic donor nephrectomy in which the preoperative evaluation of the patient gave no indication of the surgical difficulties that were encountered intraoperatively, resulting in substantial bleeding, a suspected gas embolism, and emergency conversion of the procedure from laparoscopic to open donor nephrectomy.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 59-yr-old man -height: 175 cm, weight: 85.5 kg, American Society of Anesthesiologists physical status I -presented as kidney donor for laparoscopic donor nephrectomy. He was healthy, on no medication, and had no previous abdominal surgery or diseases of the urinary tract. The preoperative computed tomography (CT) scan evaluation of his kidneys confirmed this by reporting a normal bilateral renal and renal vascular anatomy. In contradiction to the preoperative CT scan findings, the surgeon discovered abnormalities in the operative field. This included extensive scarring surrounding the left kidney, adenopathy near the right hilum, and a large branch lumbar vein entering the renal vein. The large branch lumbar vein was clipped but the clips dislodged, causing significant blood loss, and a suspected gas embolus. The procedure was converted to an emergency open donor nephrectomy. Postoperatively the patient made a full recovery.

show abstract

Massive Intraoperative Pulmonary Embolus Diagnosed by Transesophageal Echocardiography

Cited by 19 publications

References 0 publications

Unexpected complication of massive intraoperative pulmonary embolism following elective sigmoidectomy in the supine position

Unexpected complication of massive intraoperative pulmonary embolism following elective sigmoidectomy in the supine position

Cardiovascular collapse during elective orthopedic surgery: massive intraoperative pulmonary thromboembolism treated with emergent cardiopulmonary bypass

Unexpected surgical difficulties leading to hemorrhage and gas embolus during laparoscopic donor nephrectomy: a case report

Contact Info

Product

Resources

About