Publication Date
2-1-2015
Journal
The Texas Heart Journal
DOI
10.14503/THIJ-13-3731
PMID
25873804
Publication Date(s)
February 2015
Language
English
PMCID
PMC4378050
PubMedCentral® Posted Date
2-1-2015
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Carcinoma, renal cell/complications/pathology/surgery; cardiovascular surgical procedures; echocardiography, transesophageal; hypotension/physiopathology; intraoperative complications; kidney neoplasms/complications; monitoring, intraoperative; neoplasm invasiveness; pulmonary embolism/diagnosis; vena cava, inferior/pathology/surgery
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Pulmonary tumor embolization from renal cell carcinoma is associated with severe cardiopulmonary morbidity and high perioperative mortality rates. We report the case of a 71-year-old woman who presented with right-sided abdominal pain. Magnetic resonance images revealed a mass originating from the upper pole of the right kidney and extending into the infrahepatic portion of the inferior vena cava. Transesophageal echocardiography was continuously used to monitor the mass during intended radical nephrectomy and tumor resection. When the right kidney was mobilized, intracaval thrombus detached and migrated to the patient's right atrium, causing severe hemodynamic instability. After emergent sternotomy and during the initiation of cardiopulmonary bypass, the mass was no longer echocardiographically detectable in the heart; it was soon removed completely from the left pulmonary artery. The mass was a renal cell carcinoma.
We recommend the use of transesophageal echocardiography as an efficient diagnostic tool in the early detection of pulmonary tumor embolization during the resection of renal cell carcinoma that involves the inferior vena cava.