Unanticipated intra-operative finding of pulmonary artery tumour thromboembolism during radical nephrectomy and caval thrombectomy: Case report and management

Abstract

We report a case of an unanticipated intra-operative transesophageal echocardiography (TEE) finding of pulmonary artery thromboembolism in a 72yr woman being prepared for radical nephrectomy and caval thrombectomy.  Intra-operative TEE performed to evaluate the extent of caval thrombus found the presence of pulmonary artery tumor thromboembolism in an otherwise asymptomatic patient after induction and prior to commencing surgery.  A chest Computed Tomography (CT) scan confirmed a large saddle tumor thromboembolus.   A multidisciplinary approach was utilized to facilitate radical nephrectomy with caval thrombectomy and pulmonary artery thromboembolectomy.  This case shows the importance of adequate perioperative imaging and utilization of intra-operative TEE to evaluate the extent of disease. To our knowledge, we are the first to present a case of RCC with cava tumour thrombus in which the pulmonary artery tumour thromboembolism was detected incidentally on intraoperative TEE.