Combined use of transesophageal echocardiography and basket catheter can prevent tumor embolism in a patient with renal cell carcinoma

Value of Transoesophageal Echocardiography for Diagnosis of Intraoperative Tumour Embolization

Malignant neoplasms such as renal cell carcinoma may invade the inferior vena cava leading to a risk of pulmonary tumour embolization during surgical excision. Although massive pulmonary tumour embolism occurs relatively rarely, it can have catastrophic consequences. We report the case of an acute intraoperative pulmonary tumour embolism during resection of a renal cell carcinoma. The use of transoesophageal echocardiography allowed the immediate diagnosis and appropriate management of the underlying cause of acute haemodynamic instability. The role of transoesophageal echocardiography in the diagnosis of pulmonary embolism is discussed.

Anesthetic management of renal cavoatrial tumor thrombus during partial cardiopulmonary bypass

A 58-year-old male patient was scheduled for the surgical removal of a cavoatrial thrombus and renal tumors during cardiopulmonary bypass without circulatory arrest. Throughout the operation, continuous monitoring for pulmonary embolism was carried out by transesophageal echocardiography. A multidisciplinary team including anesthetists, urologists, and cardiovascular and gastrointestinal surgeons performed the operation successfully. This case report highlights the importance of anesthetic management in renal-cell carcinoma patients with a cavoatrial thrombus.

Intraoperative transesophageal echocardiography for inferior vena caval tumor thrombus in renal cell carcinoma

BACKGROUND

We investigated the advantages of intraoperative transesophageal echocardiography (TEE) during inferior vena caval tumor thrombectomy in renal cell carcinoma (RCC).

METHODS

Five patients with RCC that extended into the inferior vena cava (IVC) underwent radical nephrectomy. To remove the tumor thrombus in the IVC, an inflated Fogarty balloon catheter was used to pull the thrombus below the level of the hepatic veins with real-time TEE monitoring.

RESULTS

In all cases, TEE monitoring during surgery provided an accurate and excellent view of the IVC thrombus. TEE was particularly helpful for the thrombectomy to minimize hepatic mobilization by using occlusion balloon catheter in two patients whose thrombus extended to the intrahepatic IVC.

CONCLUSIONS

Intraoperative real-time TEE monitoring is a safe, minimally invasive technique that can provide accurate information regarding the presence and extent of IVC involvement, guidance for placement of a vena caval clamp, confirmation of complete removal of the IVC thrombus and intervention using catheters to assist in thrombectomy.