title: [Survival after intraoperative pulmonary embolism of a patient with left adrenal tumor].
abstract: We report a case of severe shock associated with intraoperative pulmonary embolism (PE). A 15-year-old girl was scheduled to undergo left adrenalectomy and removal of vena cava tumor thrombi. She had suffered from preoperative PE and a temporary IVC filter had been inserted. After left adrenalectomy and removal of vena cava tumor thrombi, IVC was declamped. Forty-five minutes after IVC declamping, circulatory collapse developed with severe hypoxia. Transesophageal echocardiography (TEE) revealed right ventricular dysfunction. We diagnosed PE and immediately started cardiopulmonary resuscitation. Ten minutes later, a stable cardio-respiratory condition was reestablished. TEE findings showed the restoration of right ventricular function. She recovered without any neurological complications. TEE may be useful for diagnosis of acute PE by secondary signs of pulmonary artery obstruction. When intraoperative PE is suspected, TEE should be used for early diagnoss of PE and monitoring cardiac function. This case also suggests that cardiopulmonary resuscitation maneuvers may ameliorate PE itself.
authors.affiliation: Department of Anesthesiology, Kagawa University, Kagawa 761-0793.
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Nagai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Taie
authors.forename: Reiko
authors.initials: R
authors.lastname: Endo
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Iwanaga
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Maekawa
mesh_terms: D000293:Adolescent; D000310:Adrenal Gland Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D000315:Adrenalectomy; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior / Q000473:pathology