Vasanthan Vishnu, Halloran Kieran, Puttagunta Lakshmi, Nagendran Jayan
Department of Surgery, University of Alberta, Edmonton, AB, Canada; Mazankowski Alberta Heart Institute, Edmonton, AB, Canada.
Department of Medicine, University of Alberta, Edmonton, AB, Canada; University of Alberta Hospital, Edmonton, AB, Canada.
Case Rep Pulmonol. 2016;2016:3257084. doi: 10.1155/2016/3257084. Epub 2016 Dec 14.
Bridging to diagnosis is an emerging technique used in end-stage cardiorespiratory failure that prolongs a patient's life using various modalities of extracorporeal lung support (ECLS) to achieve antemortem diagnosis. Pulmonary tumor embolism occurs when cell clusters travel from primary malignancies through venous circulation to the lungs, causing respiratory failure through inflammatory and venoocclusive pathways. Due to its nonspecific symptomatology, pulmonary tumor embolism remains an elusive diagnosis antemortem. Herein, we bridge a patient who presented in acute respiratory failure to the diagnosis of pulmonary tumor embolism from a gastric signet-ring cell carcinoma using ECLS modalities including venoarterial extracorporeal membrane oxygenation and centrally cannulated Novalung pumpless extracorporeal lung assist. We demonstrate the utility of this approach in diagnostically uncertain cases in unstable patients who are potentially acceptable ECLS and transplant candidates.
桥接诊断是一种用于终末期心肺衰竭的新兴技术，它通过各种体外肺支持（ECLS）方式延长患者生命，以实现生前诊断。肺肿瘤栓塞是指细胞团从原发性恶性肿瘤通过静脉循环转移至肺部，通过炎症和静脉闭塞途径导致呼吸衰竭。由于其症状不具特异性，肺肿瘤栓塞在生前诊断中仍然难以捉摸。在此，我们使用包括静脉-动脉体外膜肺氧合和中心插管式诺瓦肺无泵体外肺辅助等ECLS方式，将一名出现急性呼吸衰竭的患者桥接至胃印戒细胞癌导致的肺肿瘤栓塞诊断。我们证明了这种方法在诊断不确定的不稳定患者中的实用性，这些患者可能适合接受ECLS和移植。
