title: Intraoperative massive pulmonary tumor embolism from clear cell sarcoma in the retroperitoneum: successful treatment using cardiopulmonary bypass.
abstract: Malignant neoplasms rarely extend into the inferior vena cava and up to the right side of the heart. Although massive pulmonary tumor embolism occurs relatively rarely, it can be a catastrophic problem. Intraoperative pulmonary tumor embolism and cardiac arrest occurred in a 68-year-old woman while dissecting the inferior vena cava to resect a pararenal tumor extending into the retrohepatic inferior vena cava. Abrupt arterial hypotension, tachycardia, and increased central venous pressure lead to the diagnosis of massive pulmonary tumor embolism. Emergency cardiopulmonary bypass was commenced under profound hypothermia and cardiac arrest. The tumors in the main pulmonary artery were extracted, and fragments of remnant tumor were retrieved by a vascular endoscope, a Fogarty catheter, and milking of the lung. Following embolectomy, the tumor in the retrohepatic to infrarenal inferior vena cava was removed and the primary tumor together with the infrarenal inferior vena cava was resected under hepatic vascular exclusion and partial cardiopulmonary bypass. The inferior vena cava below the renal veins was not reconstructed. The patient recovered with slight retrograde amnesia. A postoperative pulmonary perfusion scintigram showed no defect in the pulmonary circulation. She is well now 8 months after surgery. Safe prevention measures should be accomplished as a part of the perioperative management of patients with inferior vena cava tumor thrombus that may be fragile, and cardiopulmonary bypass should always be stand-by on surgery.
authors.affiliation: Second Department of Surgery, Gunma University Faculty of Medicine, Maebashi, Japan. sohwada@med.gunma-u.ac.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Ohwada
authors.forename: Susumu
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Kawashima
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshikawa
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Hamada
authors.forename: Naoki
authors.initials: N
authors.lastname: Tomizawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Kawate
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Morishita
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating; D010690:Phlebography; D011655:Pulmonary Embolism / Q000150:complications / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D012186:Retroperitoneal Neoplasms / Q000473:pathology / Q000601:surgery*; D018227:Sarcoma, Clear Cell / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery