title: Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection.
abstract: OBJECTIVE
  Chondroblastic osteosarcoma requiring surgical intervention is associated with a high risk of pulmonary tumour embolism. Rapid intraoperative diagnosis with transesophageal echocardiography (TEE) allowed changing the management plan and treatment of a life-threatening pathology.
  
  
  METHODS
  A 32-yr-old female with right pelvic chondrosarcoma presented for right hemipelvectomy. Two hours into the operation during ligation of the iliac blood vessels the patient's hemodynamic condition deteriorated and was followed by cardiac arrest. TEE was performed immediately and revealed massive tumour embolism in the right and left pulmonary arteries. Large tumour emboli were removed from the right and left pulmonary arteries after median sternotomy under cardiopulmonary bypass and moderate hypothermia. The hemipelvectomy was completed on the next day after fluid and inotropic agent resuscitation. An inferior vena cava filter was placed below the renal veins. The patient was discharged from hospital ten days after the surgery.
  
  
  CONCLUSIONS
  This case report illustrates the important role TEE can play in the early diagnosis and subsequent surgical treatment of noncardiac emergencies. Intraoperative TEE can have a significant impact on the decision making process in life threatening emergencies.
authors: Department of Anesthesiology, University of Washington Medical Center, Seattle, Washington, USA.
authors: Lee
authors: L
authors: Newkirk
authors: Youri
authors: Y
authors: Vater
authors: Donald
authors: D
authors: Oxorn
authors: Michael
authors: M
authors: Mulligan
authors: Ernest
authors: E
authors: Conrad
mesh_terms: D000328:Adult; D001859:Bone Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002804:Chondroblastoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D005260:Female; D006428:Hemipelvectomy; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016343:Monitoring, Intraoperative / Q000379:methods*; D009360:Neoplastic Cells, Circulating; D012516:Osteosarcoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010384:Pelvic Bones / Q000473:pathology / Q000601:surgery; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D016306:Vena Cava Filters