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영남의대학술지 Vol.24_No.2 Suppl. P.S731-736, Dec. 2007

Case Report

심도 저체온 순환 정지를 이용한 급성 폐 색전증이 동반된 신세포암의 수술적 치료 -1 예 보고-

Surgical Treatment of Renal Cell Carcinoma with Acute Pulmonary Embolism Using Deep Hypothermic Circulatory Arrest -A Case Report-

이동협, 박동춘*
영남대학교 의과대학 흉부외과학교실, 비뇨기과학교실*
책임저자:이동협, 대구광역시 남구 대명동 317-1, 영남대학교 의과대학 흉부외과학교실
Tel: (053) 620-3883, Fax: (053) 626-8660
E-mail: dhlee@med.yu.ac.kr

December 30, 2007


Renal cell carcinoma occasionally invades the inferior vena cava and rarely extends to the right atrium and occurred massive pulmonary embolism. A healthy 54-year-old man presented to the emergency room with anterior chest pain, dyspnea and hypotension from which he had been suffering for several hours. We diagnosed him as left renal cell carcinoma with acute both pulmonary arteries embolism. The patient underwent a complex surgical procedure in which left radical nephrectomy, inferior vena cava thrombectomy and both pulmonary arteries thromboembolectomy under deep hypothermic circulatory arrest. Total circulatory arrest time was 44 minutes. We should use many inotropic agents for weaning of cardiopulmonary bypass. The patient had many postoperative complications including of acute renal failure, respiratory distress and sepsis. He died from septic shock and multi organ failure at 36th postoperative day.

Key Words: Renal cell carcinoma, Acute pulmonary embolism, Deep hypothermic circulatory arrest


1. Veinot JP, Ford SE, Price RG. Subacute cor pulmonale due to tumor embolization. Arch Pathol Lab Med 1992 Feb;116(2):131-4.

2. Kubota H, Furuse A, Kotsuka Y, Yagyu K, Kawauchi M, Saito H. Sussessful management of massive pulmonary tumor embolism from renal cell carcinoma. Ann Thorac Surg 1996 Feb;61(2):708-10.

3. Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Ciculation 2006 Jan 31;113(4):577-82.

4. Marshall VF, Middleton RG, Holswade GR, Goldsmith EI. Surgery for renal cell carcinoma in the vena cava. J Urol 1970 Apr;1970(4): 414-20.

5. King MB, Harmon KR. Unusual forms of tumor embolism. Clin Chest Med 1994 Sep; 15(3):561-80.

6. Rossi SE, Goodman PC, Franquet T. Nonth- rombotic pulmonary emboli. Am J Roentgentol 2000 Jan;174(6):1499-508.

7. Shepard JAO, Moore EH, Templeton PA, McLoud TC. Pulmonary intravascular tumor emboli: dilated and beaded peripheral pulmonary arteries at CT. Radiology 1993 Jan;187(3):797- 801.

8. Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep vein thrombosis. New Engl J Med 1998 Feb 12;338 (7):409-15.

9. Thabut G, Thabut D, Myers RP, Bernard- Chabert B, Marrash-Chahla R, Mal H. Thrombolytic therapy of pulmonary embolism: a meta-analysis. J Am Coll Cardiol 2002 Nov;40(9):1660-7.

10. Gulba DC, Schmid C, Borst HG, Lichtlen P, Dietz R, Luft FC. Medical compared with surgical treatment for massive pulmonary embolism. Lancet 1994 Mar 3;343(8897):576-7.

11. Meneveau N, Seronde MF, Blonde MC, Legalery P, Didier-Petit K, Briand F, et al. Management of unsuccessful thrombolysis in acute massive pulmonary embolism. Chest 2006 Apr;129(4): 1043-50.

12. Digonnet A, Moya-Plana A, Aubert S, Flecher E, Bonnet N, Leprince P, et al. Acute pulmonary embolsim: a current surgical approach. Interact Cardiovasc Thorac Surg 2007 Feb;6(1):27-9.