하대정맥혈전이 있는 간암환자에서 심초음파도로 진단한 우심장내 Tumor Emnolism

Abstract

Pulmonary thromboembolism is a leading cause of morbidity and mortality. Many patients dying of pulmonary thromboembolism have serious underlying illness such as cancer and congestive heart failure. Cancer patients are prone to both thrombotic and tumor embolism. In cancer patients, tumor pulmonary embolism and thrombotic pulmonary embolism can be associated with dyspnea, cor pulmonale and pulmonary hypertension, We presented a female patient of 63 year-old age of a hepatoma with inferior vena cava thrombosis. She had been transferred to the intensive care unit in state of refractory hypoxemia with 100% oxygen inhalation. Perfusion scan showed 60.71% defect in right lung and 39.28% defect in left lower lung field. Heparin infusion was done with the impression of pulmonary embolism without effect. Initial hemodynamic data with insertion of pulmonary artery catheter showed that cardiac index, 1.62 L/minute/M², right atrial pressure, 28 mmHg, pulmonary capillary wedge pressure 14 mmHg. Cardiac index did not increase in spite of dobutamine and dopamine infusion. Right atrial pressure increased to 29 mmHg but pulmonary capillary wedge pressure was 11 mmHg with fluid administration. Echocardiogram revealed that mass, 7(8 cm of size, was in right heart in connection to inferior vena cave thrombus. Tumor embolism from hepatoma would be suspected in our patient, but we did not confirm that case with the biopsy or autopsy. Echocardiography with pulmoary artery catheter insertion would be helpful to diagnose the disease which was suspected of pulmonary embolism and tumor embolism in cancer patient. (Korean J Anesthesiol 1995; 29: 442∼446)