Sharda Rajan, Deutscher Raymond, Christodoulou Chris, Horne David, Freed Darren H, McGregor Thomas
Section of Urology, Department of Surgery, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB;
Can Urol Assoc J. 2013 May-Jun;7(5-6):E381-5. doi: 10.5489/cuaj.1224.
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.
我们报告了一例72岁女性患者，在准备进行根治性肾切除术和腔静脉血栓切除术时，术中经食管超声心动图（TEE）意外发现肺动脉血栓栓塞。在术中进行TEE评估腔静脉血栓范围时，我们在诱导后、手术前发现一名无症状患者存在肺动脉肿瘤血栓栓塞。胸部计算机断层扫描证实有一个巨大的鞍形肿瘤血栓栓子。采用多学科方法促进根治性肾切除术、腔静脉血栓切除术和肺动脉血栓切除术。该病例显示了围手术期充分影像学检查以及使用术中TEE评估疾病范围的重要性。据我们所知，我们是首例报告在术中TEE时偶然发现肾细胞癌合并腔静脉肿瘤血栓且伴有肺动脉肿瘤血栓栓塞的病例。
