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Case Reports
. 2022 Mar 16;4(6):359-363.
doi: 10.1016/j.jaccas.2022.01.008.

Percutaneous Large Bore Aspiration Thrombectomy of Tumor Embolism Causing Massive Pulmonary Embolism

Antony Gayed  1 , Stephen Stringfellow  1 , Ricardo Yamada  1 , Thor Johnson  1 , Chelsea Wright-Void  1 , Christopher Hannegan  1
Affiliations
Case Reports

Percutaneous Large Bore Aspiration Thrombectomy of Tumor Embolism Causing Massive Pulmonary Embolism

Antony Gayed et al. JACC Case Rep. .

Abstract

We used aspiration thrombectomy to treat a 66-year-old man with renal cell carcinoma undergoing radical nephrectomy and caval thrombectomy with a massive pulmonary artery tumor embolism. (Level of Difficulty: Intermediate.).

Keywords: CT, computed tomography; ICU, intensive care unit; IVC, inferior vena cava; LPA, left pulmonary artery; PA, pulmonary artery; RCC, renal cell carcinoma; TEE, transesophageal echocardiogram; cancer; chest pain; postoperative; pulmonary circulation; right ventricle; thrombus.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Computed Tomography Pulmonary Angiography of Central Pulmonary Embolism Computed tomography pulmonary angiographic view demonstrating near-occlusive left pulmonary artery thrombus in (A) axial, (B) coronal, and (C) sagittal multiplanar reformats (arrows).
Figure 2
Figure 2
Computed Tomography Pulmonary Angiography Findings of Right Heart Strain Abnormal right ventricle: left ventricle ratio of 1.2.
Figure 3
Figure 3
Computed Tomography of Inferior Vena Cava Tumor Thrombus Coronal computed tomography demonstrating inferior vena cava thrombus (arrowheads) adjacent to a nephrectomy staple (arrow).
Figure 4
Figure 4
Inferior Venacavagram Inferior venacavagram demonstrating large nonocclusive thrombus (arrowheads) extending from the ligated right renal vein (arrow).
Figure 5
Figure 5
Pulmonary Thrombectomy Gross Pathology Tumor aspirated from the main and left pulmonary arteries. Pathologic examination revealed thrombus with extensive clear cell renal cell carcinoma. (11-cm scalpel for scale.)
Figure 6
Figure 6
Histopathology Clear cell renal cell carcinoma in intravascular thrombus (A) with histologic appearance similar to that of original renal cell carcinoma (B). (Hematoxylin & eosin staining, ×200.)
Figure 7
Figure 7
Pulmonary Angiography Pulmonary angiograms before (A) and after (B) thrombectomy demonstrating near-occlusive left pulmonary artery (LPA) filling defect (arrows), which resolved with thrombectomy. (Left pulmonary artery caliber 3.0 cm.)
See this image and copyright information in PMC

References

    1. Kayalar N., Leibovich B.C., Orszulak T.A., Schaff H.V., Sundt T.M., et al. Concomitant surgery for renal neoplasm with pulmonary tumor embolism. J Thorac Cardiovasc Surg. 2010;139:320–325. - PubMed
    1. Shuch B., Larochelle J.C., Onyia T., Vallera C., Margulis D., Pantuck A.J., et al. Intraoperative thrombus embolization during nephrectomy and tumor thrombectomy: critical analysis of the University of California-Los Angeles experience. J Urol. 2009;181:492–498. - PubMed
    1. Wang K.R. Massive postoperative pulmonary artery tumor embolism from renal cell carcinoma. Anesthesiology. 2014;120:481. - PubMed
    1. Kobayashi T., Ogura K., Nishizawa K., Muranaka H., Ono H., Oda T., et al. Successful recovery from a massive pulmonary artery tumor embolism occurring during surgery for renal cell carcinoma. Int J Urol. 2004;11:114–116. - PubMed
    1. Kostibas M.P., Arora V., Gorin M.A., Ball M.W., Pierorazio P.M., Allaf M.E., et al. Defining the role of intraoperative transesophageal echocardiography during radical nephrectomy with inferior vena cava tumor thrombectomy for renal cell carcinoma. Urology. 2017;107:161–165. - PubMed

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