Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Abstract

Purpose: Chondroblastic osteosarcoma requiring surgical intervention is associated with a high risk of pulmonary tumour embolism. Rapid intraoperative diagnosis with transesophageal echocardiography (TEE) allowed changing the management plan and treatment of a life-threatening pathology. Clinical features: A 32-yr-old female with right pelvic chondrosarcoma presented for right hemilpelvectomy. Two hours into the operation during ligation of the iliac blood vessels the patient's hemodynamic condition deteriorated and was followed by cardiac arrest. TEE was performed immediately and revealed massive tumour embolism in the right and left pulmonary arteries. Large tumour emboli were removed from the right and left pulmonary arteries after median sternotomy under cardiopulmonary bypass and moderate hypothermia. The hemipelvectomy was completed on the next day after fluid and inotropic agent resuscitation. An inferior vena cava filter was placed below the renal veins. The patient was discharged from hospital ten days after the surgery. Conclusion: This case report illustrates the important role TEE can play in the early diagnosis and subsequent surgical treatment of non-cardiac emergencies. Intraoperative TEE can have a significant impact on the decision making process in life threatening emergencies.