Open AccessUnanticipated intra-operative finding of pulmonary artery tumour thromboembolism during radical nephrectomy and caval thrombectomy: Case report and management
Author(s) -
Rajan Sharda,
Raymond Deutscher,
Chris Christodoulou,
David Horné,
Darren H. Freed,
Thomas McGregor
Publication year - 2013
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.1224
Subject(s) - medicine , thrombus , nephrectomy , asymptomatic , perioperative , pulmonary artery , radiology , surgery , kidney
We report a case of an unanticipated intra-operative transesophageal echocardiography (TEE) finding of pulmonary artery thromboembolism in a 72yr woman being prepared for radical nephrectomy and caval thrombectomy. Intra-operative TEE performed to evaluate the extent of caval thrombus found the presence of pulmonary artery tumor thromboembolism in an otherwise asymptomatic patient after induction and prior to commencing surgery. A chest Computed Tomography (CT) scan confirmed a large saddle tumor thromboembolus. A multidisciplinary approach was utilized to facilitate radical nephrectomy with caval thrombectomy and pulmonary artery thromboembolectomy. This case shows the importance of adequate perioperative imaging and utilization 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.