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CARDIOVASCULAR ANESTHESIA

The Role of Transesophageal Echocardiography in Rapid Diagnosis and Treatment of Migratory Tumor Embolus

Hsiupei Chen, MD^*, Victor Ng, MD, Christopher J. Kane, MD, and Isobel A. Russell, MD PhD

*Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina; and Departments of Anesthesiology and Urology, University of California at San Francisco, San Francisco, California

Address correspondence and reprint requests to Hsiupei Chen, MD, Duke Pain and Palliative Care Clinic, 932 Morreene Rd., Durham, NC 27713. Address e-mail to chen0025{at}mc.duke.edu

Transesophageal echocardiography (TEE) is sometimes used in renal cell carcinoma excision for evaluating the extension of tumor in the inferior vena cava (IVC), characterizing the tumor anatomy, monitoring the tumor during surgical mobilization, and assessing cardiac function. Although the risk for embolization is small, when embolization does occur, its consequences can be catastrophic. In this case report, we describe the crucial role of TEE in diagnosing an intraoperative migratory embolus from the IVC to the pulmonary artery and also provide both single-frame photographs and Internet-accessible videos of the event. Our case illustrates the key role that TEE played in the intraoperative management of a patient with renal cell carcinoma undergoing surgical excision of tumor. TEE aided in accurately defining the cephalad extent of the thrombus, provided continuous monitoring of the thrombus during surgical manipulation, and allowed immediate identification of its embolization and proper notification of the surgeons. This case illustrates the crucial role TEE played in the management of a migratory tumor embolus and argues for its routine use during excision of renal cell carcinomas invading the IVC.

IMPLICATIONS: Transesophageal echocardiography (TEE) helped characterize, monitor, and facilitate excision of a renal cell carcinoma extending into the inferior vena cava. After the tumor unexpectedly embolized, TEE played a life-saving role in the diagnosis and treatment of the tumor embolus. We provide Internet-accessible videos of the tumor thrombus in transit and propose routine TEE use during excision of renal cell carcinomas extending into the inferior vena cava.

This article has been cited by other articles:

				J. B. Cywinski and J. F. O'Hara Jr Transesophageal Echocardiography to Redirect the Intraoperative Surgical Approach for Vena Cava Tumor Resection Anesth. Analg., November 1, 2009; 109(5): 1413 - 1415. [Full Text] [PDF]