腎癌摘出術中に発生した急性肺塞栓に対する緊急手術の１例　　術中経食道エコーおよび血管内視鏡の有用性

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  • A Case of Successful Treatment of Intraoperative Pulmonary Tumor Embolism Using Pulmonary Angioscopy under Cardiopulmonary Bypass.
  • 術中経食道エコーおよび血管内視鏡の有用性

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The case involved a 73-year-old woman who underwent surgical resection for right renal cell carcinoma extending to the inferior vena cava. During surgery the tumor thrombus disappeared from the inferior vena cava. We performed transesophageal echocardiography and detected the tumor thrombus in the right ventricle. Therefore, we immediately tried to remove the thrombus using cardiopulmonary bypass. However, we could not find the tumor thrombus in the right ventricle or in the main pulmonary artery. We used angioscopy of the pulmonary artery and detected the tumor thrombus at the orifice of the inferior pulmonary artery. The tumor thrombus was removed under direct visualization. In the event of an intraoperative pulmonary embolism, simple and safe techniques for exact and rapid diagnosis are needed. Intraoperative angioscopy allows direct visualization of the pulmonary arterial branches and appears to be very useful for detection of tumor thrombi even in emergency cases.

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