Massive Pulmonary Calculi Embolism

Abstract

Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before.We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output.This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism.

Candida endophthalmitis and Candida pneumonia after trans‐urethral lithotripsy: A case report

“…Although lithotripsy is a minimally invasive intervention, it may lead to complications such as hemorrhage, perforation, mucosal laceration, infection, damage to nearby organs, and displacement of calculi or residue 11 . In the presented case, clinical manifestations occurred shortly after TUL, suggesting a possible relationship between the procedure and disseminated candidiasis.…”

“…We found two case reports of lung complications after TUL (Table 1 ). 11 , 12 Cultures and PCR of BAL that are positive for Candida spp. cannot be the sole basis for definitive CP diagnosis.…”