title: Unanticipated intra-operative finding of pulmonary artery tumour thromboembolism during radical nephrectomy and caval thrombectomy: Case report and management.
abstract: We report a case of an unanticipated intra-operative transesophageal echocardiography (TEE) finding of pulmonary artery thromboembolism in a 72-year-old woman being prepared for radical nephrectomy and caval thrombectomy. Upon intra-operative TEE to evaluate the extent of caval thrombus, we found a pulmonary artery tumour thromboembolism in an otherwise asymptomatic patient after induction and prior to surgery. A chest computed tomography confirmed a large saddle tumour thromboembolus. A multidisciplinary approach was used to facilitate radical nephrectomy with caval thrombectomy and pulmonary artery thromboembolectomy. This case shows the importance of adequate perioperative imaging and use of intra-operative TEE to evaluate the extent of disease. To our knowledge, we are the first to present a case of RCC with cava tumour thrombus in which the pulmonary artery tumour thromboembolism was detected incidentally on intraoperative TEE.
authors.affiliation: Section of Urology, Department of Surgery, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB;
authors.forename: Rajan
authors.initials: R
authors.lastname: Sharda
authors.forename: Raymond
authors.initials: R
authors.lastname: Deutscher
authors.forename: Chris
authors.initials: C
authors.lastname: Christodoulou
authors.forename: David
authors.initials: D
authors.lastname: Horne
authors.forename: Darren H
authors.initials: DH
authors.lastname: Freed
authors.forename: Thomas
authors.initials: T
authors.lastname: McGregor