Left femoral arterial occlusion due to tumor embolism after left pneumonectomy; a case report.

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A 62-year-old-man was admitted to our hospital for evaluation of an abnormal shadow in the left upper lung field on his chest X-ray film. We diagnosed lung cancer originating from left B<SUP>1+2</SUP> (cT3N1M0, stage IIIA). The pulmonary angiogram showed no filling of the left superior pulmonary vein. Left pneumonectomy was performed. The left superior pulmonary vein was ligated within the pericardium. Two hours after surgery, the patient's left lower extremity became cold and pulses were not palpable below the femoral artery. A Diagnosis of acute left femoral embolism was established and embolectomy was performed through the left femoral artery. A tumor embolism was found.<BR>Tumor embolism is a rare, but severe complication of primary lung cancer. So, to prevent this complicaton, it is very important to recognize how the tumor invades the pulmonary venous lumen. But it may be very difficult to do this preoperatively, and even during the operation. Based on our experience and data from 27 cases reported in the literature, we think that large and poorly differentiatd tumors that spread to the hilum may invade the pulmonary venous lumen. In such cases, the possibility of pulmonary venous invasion should be considered.
特定非営利活動法人日本呼吸器外科学会の論文