Three cases of acute pulmonary thromboembolism diagnosed by transesophageal echocardiography

We report 3 cases of acute pulmonary thromboembolism (PTE) diagnosed by transesophageal echocardiography (TEE). In all these cases, cardiovascular state of the patient was unstable and therefore computerized tomography and catheterization of the pulmonary artery for diagnosis of PTE could not be performed. TEE was useful for diagnosis of acute PTE. All three patients passed away eventually and we had a difficult experience for treatment of acute PTE. We should take various measures against deep vein thrombosis for prevention of acute PTE.     

Pulmonary cryptococcosis preoperatively diagnosed as lung cancer

A 60-year-old woman was referred to our hospital with an abnormal shadow on chest radiography. Chest computed tomography( CT) showed a nodular shadow 1 cm in diameter with spiculation at S6a of the right inferior lobe. The patient was diagnosed as having a class V squamous cell carcinoma by bronchoscopic exfoliative cytology and was thus hospitalized for surgery. The nodule was resected by partial resection of the lung for intraoperative rapid pathology. Since the diagnosis was an inflammatory node, further procedure was not performed. Histopathological examination of the permanent specimen revealed a diagnosis of pulmonary cryptococcosis.     

Acute pulmonary embolism following lung resection: report of two cases

We reported 2 cases of acute pulmonary embolism after resection for lung cancer. A 47-year-old male was admitted to our hospital with ground-glass opacity (GGO) on a chest computed tomography (CT). We performed a right upper lobectomy and node dissection (ND) 2a dissection. Two days after the operation, he developed hypotension and hypoxemia. He was diagnosed as acute pulmonary embolism by chest CT and lung scintigram. A 68-year-old women was performed right S6 segmentectomy for lung cancer. The next day, she complained of sudden chest discomfort and dyspnea. She was diagnosed as acute pulmonary embolism by chest CT. Immediately, we started anticoagration therapy with heparin and their condition were improved. It was very important to early diagnose and start anticoagration therapy immediately for acute pulumonary embolism.     

Primary lung cancer incidentally diagnosed in lung biopsy for diffuse pulmonary disease

We here presented 2 cases of interstitial pneumonia with lung adenocarcinoma incidentally diagnosed by partially resected lung for diffuse pulmonary disease. CASE 1: A 78-year-old female was admitted to the hospital complaining of productive cough and general fatigue. The chest computed tomography (CT) revealed diffuse honey comb pattern in bilateral lung field especially in the right lower lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as diffuse spreading well differentiated adenocarcinoma. CASE 2: A 59-year-old male was admitted to the hospital complaining of dyspnea and general fatigue. The chest X-ray revealed right pneumothorax and chest CT revealed diffuse honey comb pattern and bullae in bilateral lung field and fibrous tumor-like lesion in the right middle lung. Video-assisted thoracoscopic lung biopsy was performed and was diagnosed as pulmonary fibrosis with papillary adenocarcinoma. CONCLUSION: It is important to examine carefully the specimen obtained from thoracoscopic lung biopsy even if interstitial pneumonia is strongly suspected.     

A systematic review of pulmonary embolism in patients with lung cancer

Pulmonary embolism (PE) is increasingly recognized as causing significant morbidity and mortality in modern societies; however, little is known about PE in patients with lung cancer. We systematically reviewed Medline, Web of Science, and the Cochrane Library databases and selected 26 studies, including 2 randomized controlled trials, and 4 prospective, 18 retrospective cohort, and 2 case-control studies. Overall incidence of PE was 3.6%. Pulmonary embolism abbreviated survival in 2 studies when the diagnosis was synchronous with lung cancer. Venous thromboembolism prophylaxis, treatment, and surveillance are inconsistently reported. Clinical outcome data pertaining to this topic are limited and of overall poor methodologic quality.     

Successful management of acute pulmonary embolism after surgery for lung cancer.

OBJECTIVE: Although many case reports of acute pulmonary embolism (APE) have been published, the literature dealing with the management of APE after resection of lung cancer is limited. This report describes seven cases of successful management of APE after surgery for lung cancer and discusses how to manage this problematic complication. METHODS: The medical charts of seven patients with APE after lobectomy and complete mediastinal lymphnode dissection were retrospectively reviewed. RESULTS: Six patients collapsed during their first attempt at walking after surgery in conjunction with a dramatic respiratory change. All these patients promptly underwent enhanced spiral computed tomography (CT) scanning. Bilateral clots were detected in all patients and one patient with a deep venous thrombus (DVT) in the femoral vein had a temporary inferior vena cava filter implanted. Non-surgical therapy was used for six patients: thrombolysis (systemic urokinase) and anticoagulant (heparin or argatroban) for four patients and only anticoagulant therapy started on the day after the operation using argatroban for two. There were no bleeding problems with these thrombolysis and/or anticoagulant therapies except in one case of hemorrhage induced by heparin usage on the day after the operation. None of the cases required allotransfusion in connection with these therapies. Thromboembolectomy was performed for one patient who was hemodynamically unstable due to massive embolism and primary atrial fibrillation. All patients were discharged from our hospital without major complications. CONCLUSIONS: Patients with pulmonary embolism after surgery for lung cancer can be treated aggressively with anticoagulants with/without fibrinolitics or even with pulmonary embolectomy on cardiopulmonary bypass, without excessive risk of bleeding complications. Enhanced spiral CT scanning was very helpful for making a simultaneous diagnosis of APE and DVT. The use of argatroban in conjunction with activated clotting time monitoring should be effective without causing bleeding problems during the early stages after pulmonary resection for lung cancer.     

胸腔镜肺癌切除术后患者静脉血栓栓塞症的预防性护理

目的探讨胸腔镜下肺癌切除术后静脉血栓栓塞症的预防性护理干预措施。方法将2017年收治的685例胸腔镜下肺癌切除术患者设为对照组,给予常规护理。将2018年收治的762例患者设为观察组,通过Caprini风险评估、分级,给予预防性护理措施。比较两组术后血液指标、胸管引流量及留置时间、血栓栓塞事件、住院时间等。结果观察组术后7d的血小板计数、D-二聚体显著低于对照组(均P0.01)。观察组术后胸管引流量、胸管留置时间、下肢静脉血栓及肺血栓栓塞发生率、住院时间、日常生活能力评分与对照组比较,差异有统计学意义(均P0.01)。结论预防性护理干预能够降低胸腔镜肺癌切除术患者的血小板计数、D-二聚体,减少血栓栓塞事件的发生。     

Post-brain angiographic asymptomatic pulmonary embolism diagnosed before general anesthesia

A 58-year-old man was scheduled for resection of a brain tumor. He had undergone brain angiography two days before the operation. His right femoral artery punctured for the insertion of a catheter, had been compressed with a sponge for six hours after the brain angiography. He had gone without food for 13 hours and drink for 11 hours before entering the operating room. He was given 2.5 mg of midazolam im as premedication. Though we found his SpO2 value decreased to 88-90%, he did not complain of any clinical symptoms. Arterial blood gas (ABG) analysis showed PaO2 of 60 mmHg with room air. We asked him to take deep breaths for five minutes, but his ABG analysis continued to show hypoxia. Therefore, his scheduled operation was canceled in order to investigate the cause of hypoxia. As chest enhanced computed tomography revealed thrombosis of 3 cm in length in the A 3 artery of his right lung, we diagnosed pulmonary embolism and treated it with continuous intravenous injection of heparin. Pulmonary thromboembolism in this case might have been due to femoral vein compression, vein congestion during extended periods of bed rest after the brain angiography, deep leg vein thrombosis produced by femoral artery injury, and dehydration before the operation. Care has to be taken for the onset of pulmonary embolism after angiography through the femoral artery. Measurement of SpO2 is useful for the early diagnosis of asymptomatic pulmonary embolism.     

Three pulmonary resections for metastatic lung cancer from hepatocellular carcinoma

We describe a patient who underwent pulmonary resection three times for metastatic lung cancer from hepatocellular carcinoma (HCC). A 56-year-old man, who had a past history of right hepatic lobectomy for HCC, was referred to our department with an abnormal finding on chest computed tomography (CT). Chest CT showed three abnormal shadows, in the right upper lobe (S3b), right middle lobe (S5), and right lower lobe (S10), respectively, and there was no evidence of intrahepatic recurrence. He underwent surgical resections (right upper lobectomy and partial resections) for the metastatic lung cancer from HCC. Subsequently, 12 and 16 months after the first pulmonary resection, metastatic lung cancer recurred, in right S6 and S9, respectively. Because there was no evidence of intrahepatic recurrence and because of the feasibility of curative resection, we performed partial pulmonary resections. He had no postoperative morbidity, and is alive with no evidence of disease 60 months after the first pulmonary resection. Twelve cases of repeat pulmonary resections for metastatic lung cancer from HCC have been reported in the literature, and the authors of these reports described that repeated pulmonary resections for metastatic lung cancer from HCC resulted in long-term survival. Repeat pulmonary resections for metastatic lung cancer from HCC can be an effective treatment for patients with such metastases.     

肺栓塞6例临床报告

目的总结肺栓塞的形成、临床特点及治疗方法.方法搜集卢旺达基本古医院1997年7月至1999年7月肺动脉栓塞6例患者临床资料,对其诊断及治疗作分析总结.结果肺动脉栓塞多见于手术后患者、老年人、久病卧床伴有高黏滞血症者,易形成深静脉血栓.临床表现为咳嗽、胸闷、胸痛、气短和呼吸困难,可通过血液流变学的检查协助诊断,多普勒彩超及血管造影、胸片确诊.结论肺栓塞易被忽视,早期诊断和治疗对改善预后很有价值.     

肺栓塞6例临床报告

目的　总结肺栓塞的形成、临床特点及治疗方法。方法　搜集卢旺达基本古医院 1997年 7月至 1999年 7月肺动脉栓塞 6例患者临床资料 ,对其诊断及治疗作分析总结。结果　肺动脉栓塞多见于手术后患者、老年人、久病卧床伴有高黏滞血症者 ,易形成深静脉血栓。临床表现为咳嗽、胸闷、胸痛、气短和呼吸困难 ,可通过血液流变学的检查协助诊断 ,多普勒彩超及血管造影、胸片确诊。结论　肺栓塞易被忽视 ,早期诊断和治疗对改善预后很有价值     

Two cases of pulmonary embolism in spinal surgeries

We experienced two cases of pulmonary embolism (PE) in the perioperative period. Although the incidence of perioperative PE is low, it may lead to a critical outcome. The first case is a 59-year-old man without risk factors of PE, scheduled for laminectomy. The end tidal CO2 of 25 mmHg and Pa(CO2) of 48 mmHg developed at the same time during the operation, suggesting PE. He was diagnosed as PE by pulmonary perfusion scan later. The second case was a 71-year-old woman with hypertension and diabetes mellitus, scheduled for laminectomy. Although there were no events during the surgery, she complained of chest pain and dyspnea after the operation. Blood gas analysis showed Pa(O2) of 55 mmHg (FI(O2) 0.4). She was also diagnosed as PE by pulmonary perfusion scan. Both patients made satisfactory progress by appropriate diagnosis and treatment. PE may occur in spite of prevention, and it is important to find out the signs of PE and to prepare for the occurrence of PE.     

Acute pulmonary embolism performed embolectomy under percutaneous cardiopulmonary support successfully after lung cancer operation

We have experienced a case of acute pulmonary embolism after lung cancer operation. The case was a 74-year-old male. He underwent left upper lobectomy due to squamous cell carcinoma. He fell into shock state suddenly on the 6th day postoperatively. We diagnosted acute pulmonary embolism, performed urgent embolectomy under percutaneous cardiopulmonary support (PCPS). Postoperative course was smooth, and he has returned to normal daily life. Urgent diagnosis and management are indispensable for acute pulmonary embolism after lung cancer operation from the aspect of residual among of pulmonary vascular bed.     

Multiple primary lung cancer diagnosed by thoracic computed tomography; report of 2 cases

Two cases of bilateral multiple primary lung cancers are presented. One is synchronous, and another is metachronous. Case 1: An abnormal shadow in the left lower lobe was found on the chest radiograph of 40-year-old female during a regular check-up. Chest computed tomography (CT) film showed a micronodule in the right S2. Left lower lobectomy was performed, followed by second-staged right S2 segmentectomy 1 month after the initial operation. Case 2: A 62-year-old female underwent left lower lobectomy for lung cancer in April 1997. Follow-up CT showed a nodule in right S8. In March 2000, right basal segmentectomy was performed for second lung cancer. Moreover, follow-up CT showed a nodule in right S3. Right wedge resection was performed for third lung cancer in July 2002. It is important to carefully examine a synchronous lesion before the operation of a primary lung cancer and to perform close follow-up surveillance for early detection of a metachronous lesion.