Percutaneous suction thrombectomy of large tumor thrombus causing massive pulmonary embolism

Abstract

We describe a patient who underwent a renal cell carcinoma resection with inferior vena cava thrombectomy complicated by tumor embolization. This resulted in massive pulmonary embolism requiring venous-arterial extracorporeal membrane oxygenation. The patient was ineligible for systemic or catheter-directed thrombolysis because of the recent surgical resection and postoperative hemorrhage. Hence, the patient underwent percutaneous suction thrombectomy with successful removal of the tumor thrombus and significant clinical improvement. This report represents a unique case of suction thrombectomy for the removal of tumor embolus from the pulmonary circulation and highlights the ability of suction thrombectomy in the management of massive pulmonary embolism.

Keywords: Continuous aspiration embolectomy; Pulmonary embolism; Renal cell carcinoma.

Fig 1

Computed tomography angiography (CTA) demonstrating the extent of the tumor embolus to the right (large arrows) and left (narrow arrows) pulmonary arterial circulation, resulting in a massive pulmonary embolus. A and B, Representative axial images. C and D, Sagittal and coronal images, respectively.

Fig 2

Initial angiogram demonstrating a large filling defect in the right superior and interlobar pulmonary arteries (arrow).

Fig 3

Tumor that was aspirated from the right superior and interlobar pulmonary arteries. Final pathologic examination revealed that the mass was indeed renal cell carcinoma (RCC).

Fig 4

Completion pulmonary angiography revealing normal filling of the superior and interlobar pulmonary arterial branches (arrow), with reactive hyperemia of the right middle and upper lobes of the lung.