Yang Jun Ho, Song Dae Hyun, Lee Chunwoo, Kang Dong Hoon, Jung Jae Jun, Kim Sung Hwan, Byun Joung Hun, Kim Jong Woo, Moon Seong Ho
Department of Thoracic and Cardiovascular Surgery, Changwon.
Gyeongsang National University School of Medicine.
Medicine (Baltimore). 2020 May;99(19):e19943. doi: 10.1097/MD.0000000000019943.
The preoperative diagnosis of massive pulmonary tumor embolism associated with renal neoplasms is relatively rare. In most cases, pulmonary tumor embolism is detected intraoperatively during renal tumor resection. Moreover, primary renal sarcoma is rare, and primary renal sarcoma complicated by pulmonary tumor embolism is extremely rare; accordingly, there is no optimal treatment for such cases. Herein, we report a case of renal sarcoma associated with pulmonary tumor embolism.
A 39-year-old man was admitted to the emergency room owing to the sudden onset of dyspnea and palpitation.
Contrast-enhanced computed tomography (CT) revealed a large mass in the right kidney involving the infrahepatic inferior vena cava, with massive pulmonary emboli in both the pulmonary arteries.
Emergency pulmonary embolectomy with radical nephrectomy was performed.
The patient experienced apparent remission of dyspnea, and resolution of right ventricle dysfunction. However, although remnant emboli were detected in the segmental arteries on postoperative CT, complete resolution of pulmonary embolism was observed after adjuvant chemotherapy.
Thus, concomitant cytoreductive nephrectomy with pulmonary embolectomy along with chemotherapy may be effective for patients with renal sarcoma with pulmonary tumor embolism.
术前诊断为与肾肿瘤相关的大量肺肿瘤栓塞相对少见。在大多数情况下，肺肿瘤栓塞是在肾肿瘤切除术中被发现的。此外，原发性肾肉瘤罕见，而并发肺肿瘤栓塞的原发性肾肉瘤极为罕见；因此，对于此类病例尚无最佳治疗方法。在此，我们报告一例与肺肿瘤栓塞相关的肾肉瘤病例。
一名39岁男性因突发呼吸困难和心悸入住急诊室。
增强计算机断层扫描（CT）显示右肾有一巨大肿块累及肝下下腔静脉，双肺动脉有大量肺栓塞。
实施了急诊肺栓子切除术及根治性肾切除术。
患者呼吸困难明显缓解，右心室功能障碍得到改善。然而，尽管术后CT显示节段动脉中仍有残余栓子，但辅助化疗后肺栓塞完全消失。
因此，对于患有肾肉瘤合并肺肿瘤栓塞的患者，联合减瘤性肾切除术、肺栓子切除术及化疗可能有效。
