Zhang Qing-Hua, Xiong Zi-Lin
Department of Cardiovascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.
Department of Cardiovascular Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China.
Int J Surg Case Rep. 2024 Dec;125:110655. doi: 10.1016/j.ijscr.2024.110655. Epub 2024 Nov 26.
This case highlights the importance of echocardiography in diagnosing pulmonary embolism and the need for careful timing of preoperative transesophageal echocardiogram in patients with potentially detachable intracardiac masses as a tumor detachment during TEE led to a life-threatening pulmonary embolism.
A 30-year-old man with a history of treated pulmonary embolism had progressive dyspnea. Tests revealed a mass in the right atrium and a new pulmonary embolism. During preoperative TEE, a free-floating mass disappeared, suggesting embolization. Surgery was immediately initiated, and a myxoma was removed from the right atrium and pulmonary artery.
Right atrial myxoma is a rare cause of PE. Routine echocardiography is essential for suspected PE patients. The detachment during TEE may be related to the procedure, handling, or anesthesia. Preoperative TEE can be a useful supplementary diagnostic tool but requires careful consideration of timing.
For pulmonary embolism diagnosis, searching for the cause is important and echocardiography is valuable. For patients with right atrial myxoma and pulmonary embolism, timely diagnosis and surgical resection are necessary, with attention to the timing of preoperative TEE examination.
本病例突出了超声心动图在诊断肺栓塞中的重要性，以及对于患有潜在可分离心内肿块的患者，术前经食管超声心动图（TEE）检查时机需谨慎把握，因为TEE过程中肿瘤分离导致了危及生命的肺栓塞。
一名有肺栓塞治疗史的30岁男性出现进行性呼吸困难。检查发现右心房有一个肿块以及新发的肺栓塞。术前TEE检查时，一个游离肿块消失，提示发生了栓塞。立即进行手术，从右心房和肺动脉切除了一个黏液瘤。
右心房黏液瘤是肺栓塞的罕见病因。对于疑似肺栓塞患者，常规超声心动图检查至关重要。TEE过程中肿块分离可能与操作、处理或麻醉有关。术前TEE可以是一种有用的辅助诊断工具，但需要仔细考虑检查时机。
对于肺栓塞诊断，寻找病因很重要，超声心动图很有价值。对于右心房黏液瘤合并肺栓塞患者，及时诊断和手术切除是必要的，同时要注意术前TEE检查的时机。
