Haddad Rui, Boasquevisque Carlos Henrique Ribeiro, Ferreira Tadeu Diniz, Reis Mario Celso Martins, Teixeira Fernando D'Imperio
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
J Bras Pneumol. 2008 Jul;34(7):537-40. doi: 10.1590/s1806-37132008000700015.
A 26-year-old patient with a voluminous primary pulmonary hemangiopericytoma in the right lung, diagnosed through previous surgical biopsy, presented irreversible cardiac arrest during the hilar dissection portion of a right pneumonectomy. The patient did not respond to resuscitation efforts. Autopsy showed total obstruction of the mitral valve by a tumor embolism. In cases of large lung masses with hilar involvement, as in the case presented, we recommend preoperative evaluation using transesophageal echocardiography, magnetic resonance imaging or angiotomography. If injury to the pulmonary vessels or atrial cavities is detected, surgery with extracorporeal circulation should be arranged in order to allow resection of the intravascular or cardiac mass, together with pulmonary resection. We recommend that care be taken in order to recognize and treat this problem in patients not receiving a preoperative diagnosis.
一名26岁患者，右肺有巨大原发性肺血管外皮细胞瘤，此前经手术活检确诊，在右肺切除术的肺门解剖部分出现不可逆心脏骤停。患者对复苏努力无反应。尸检显示二尖瓣被肿瘤栓子完全阻塞。对于如本病例所示的累及肺门的大肺肿块病例，我们建议术前使用经食管超声心动图、磁共振成像或血管造影进行评估。如果检测到肺血管或心房腔损伤，应安排体外循环手术，以便在进行肺切除的同时切除血管内或心脏肿块。我们建议在未接受术前诊断的患者中注意识别和处理这一问题。
