title: Early detection of a cavopulmonary tumor embolus with the use of transesophageal echocardiography.
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.
authors: Magdy M
authors: MM
authors: El-Sayed Ahmed
authors: Raed M
authors: RM
authors: Al-Najjar
authors: Muhammad
authors: M
authors: Aftab
authors: James M
authors: JM
authors: Anton
authors: John S
authors: JS
authors: Colen
authors: Ross M
authors: RM
authors: Reul
mesh_terms: D000368:Aged; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D017128:Embolectomy; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D009392:Nephrectomy / Q000009:adverse effects*; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000601:surgery; D012307:Risk Factors; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000473:pathology
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