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Review
. 2019 Jan 31;19(1):39.
doi: 10.1186/s12887-019-1413-y.

Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

Atsuna Fukuda  1 , Takeshi Isoda  2   3 , Naoya Sakamoto  4 , Keisuke Nakajima  1 , Tetsuya Ohta  1
Affiliations
Review

Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

Atsuna Fukuda et al. BMC Pediatr. .

Abstract

Background: Finding an abdominal mass or hematuria is the initial step in diagnosing Wilms tumor. As the first manifestation of Wilms tumor, it is exceedingly rare for pulmonary tumor embolism to present with cardiac arrest. A case of a patient whose sudden cardiac arrest due to massive pulmonary tumor embolism of Wilms tumor was not responsive to resuscitation is presented.

Case presentation: The patient was a five-year-old girl who collapsed suddenly during activity in nursery school and went into cardiac arrest in the ambulance. Unfortunately, she was not responsive to conventional resuscitation. A judicial autopsy conducted at the local police department showed the main cause of her sudden cardiac arrest was attributed to multiple pulmonary tumor embolisms of stage IV Wilms tumor.

Conclusions: Except for one reported case, treatments were not successful in all eight cardiac arrest cases with pulmonary tumor embolism of Wilms tumor. These results indicate that it is challenging not only to make an accurate diagnosis, but also to provide proper specific treatment in the cardiac arrest setting. We propose that flexible triage and prompt transfer to a tertiary hospital are necessary as an oncologic emergency to get such patients to bridging therapy combined with extracorporeal membrane oxygenation or immediate surgical intervention under cardiopulmonary bypass.

Keywords: Cardiac arrest; Case report; Massive pulmonary tumor embolism; Wilms tumor.

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Not applicable.

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Written and signed consent for publication was obtained from the parents.

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The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
a Plain postmortem CT scan shows a right tumor mass extending into the inferior vena cava (IVC). b Right tumor and normal left kidney are shown. c The tumor extends into the IVC. d Multiple greyish tumors and blood clots are observed in the right pulmonary artery. e Greyish tumor occupies the left pulmonary artery. Black bar represents 5 cm
Fig. 2
Fig. 2
a Outcomes of Wilms tumor with massive pulmonary embolism (PE) in past reports and the present case. b Proposed strategy for Wilms tumor with massive PE and cardiac arrest or shock. ECPR, extracorporeal cardiopulmonary resuscitation; PH, pulmonary hypertension; RV, right ventricle
See this image and copyright information in PMC

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