Intraoperative pulmonary embolism due to nephrectomy for renal carcinoma: Value of perioperative monitoring and immediate embolectomy using cardiopulmonary bypass

Abstract

A case is reported of a patient who experienced sudden hemodynamic instability and cardiopulmonary arrest during a nephrectomy for renal carcinoma. Preoperative computed (CT) and nuclear magnetic resonance (NMR) tomography detected a tumor of the right kidney invading the renal vein and the inferior vena cava with consequential thrombus obstruction of the vena cava. Peridural combined with general anesthesia was used. Due to the planned operation, monitoring of hemodynamic parameters with direct blood pressure measurement, arterial blood gas monitoring, and capnography was of outstanding value. The drop in arterial blood pressure and decrease of end-tidal CO₂ tension (P _ET CO₂) in the capnography in combination with the typical clinical setting initiated an immediate sternotomy and embolectomy with cardiopulmonary bypass. The diagnosis of pulmonary embolism due to parts of the renal tumor was confirmed and after reestablishment of stable hemodynamic conditions the nephrectomy was completed. The postoperative course was without further complications. In a patient with suspected pulmonary embolism during surgery for a renal carcinoma that is invading the inferior vena cava, an immediate pulmonary embolectomy is proposed when further diagnostic procedures are immediately available.