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Myocardial infarction due to tumor embolization following pulmonary resection
Insights
A rare fatal case of tumor embolization occurred after surgery for metastatic pulmonary fibroliposarcoma. This highlights the risk of coronary artery obstruction by tumor emboli during pulmonary resection.
Area of Science:
- Oncology
- Cardiology
- Thoracic Surgery
Background:
- Metastatic fibroliposarcoma to the lungs presents a surgical challenge.
- Systemic tumor embolization is a rare but potentially fatal complication.
Observation:
- A patient developed massive systemic tumor embolization, including coronary artery involvement, post-resection of a metastatic pulmonary fibroliposarcoma.
- Cardiac-specific creatine kinase isoenzyme (MB-CK) elevation indicated myocardial damage from tumor emboli obstructing coronary arteries.
- Preoperative computed tomography revealed the pulmonary mass contiguous with the inferior pulmonary vein and left atrium.
Findings:
- The case demonstrates a direct link between pulmonary tumor resection and systemic tumor embolization.
- Myocardial damage was confirmed by elevated MB-CK levels due to coronary artery tumor emboli.
- Preoperative imaging identified anatomical relationships predisposing to embolization.
Implications:
- Surgeons must be aware of the risk of tumor embolization during pulmonary resection of metastatic tumors.
- Preoperative identification of tumor contiguity with vascular structures is crucial.
- Cardiopulmonary bypass and direct visualization/excision of atrial tumor extensions may be necessary to prevent embolization.
Abstract:
A fatal case of massive systemic tumor embolization, with involvement of the coronary arteries, which occurred following resection of a metastatic pulmonary fibroliposarcoma, is presented. Elevation of the cardiac specific creatine kinase isoenzyme (MB-CK) documented myocardial damage due to obstruction of the coronary arteries by tumor emboli. The preoperative computed tomography scan demonstrated contiguity between the pulmonary mass, the inferior pulmonary vein and left atrium. In future cases this finding should alert the surgeon that cardiopulmonary bypass and removal of the left artial extension of the tumor under direct vision may be required to prevent embolization during pulmonary resection.