El-Sayed Ahmed Magdy M, Al-Najjar Raed M, Aftab Muhammad, Anton James M, Colen John S, Reul Ross M
Tex Heart Inst J. 2015 Feb 1;42(1):66-9. doi: 10.14503/THIJ-13-3731. eCollection 2015 Feb.
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.
肾细胞癌导致的肺肿瘤栓塞与严重的心肺并发症及高围手术期死亡率相关。我们报告一例71岁女性，她因右侧腹痛就诊。磁共振成像显示一个肿块起源于右肾上极并延伸至下腔静脉肝下部分。在拟行根治性肾切除术及肿瘤切除术期间，经食管超声心动图持续用于监测该肿块。当游离右肾时，腔内血栓脱落并迁移至患者右心房，导致严重的血流动力学不稳定。紧急开胸并开始体外循环后，心脏内的肿块在超声心动图上不再可检测到；它很快从左肺动脉完全移除。该肿块为肾细胞癌。我们建议将经食管超声心动图作为一种有效的诊断工具，用于早期检测涉及下腔静脉的肾细胞癌切除术中的肺肿瘤栓塞。
