Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.05.011
Brazilian Journal of Anesthesiology
Case Report

Successful perioperative management of a primary pulmonary arterial angiosarcoma: case report

Manejo perioperatório bem-sucedido de angiossarcoma arterial pulmonar primário: relato de caso

Ashish Anil Bartakke, Jose Ignacio Saez de Ibarra Sanchez

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Abstract

Introduction
Primary pleomorphic pulmonary angiosarcomas are extremely rare tumors which could be easily mistaken for pulmonary emboli.

Background and findings
We describe the successful perioperative management of a patient with a pulmonary arterial mass which turned out to be a primary pulmonary angiosarcoma. The severe pulmonary hypertension was a particular challenge compounded with the site and adhesions of the tumor, and pulmonary hemorrhage. The procedure was successfully performed with strict hemodynamic control ensuring stable systemic and pulmonary arterial pressures using perioperative transesophageal echocardiography to continuously monitor cardiac function, along with other standard cardiac surgical monitors including depth of anesthesia monitoring.

Conclusion
Tight hemodynamic control, ensuring stable pulmonary arterial pressures using perioperative echocardiography, and thorough preparation with measures to reduce and prevent increase in pulmonary arterial pressure along with close communication within the multi-disciplinary team are essential for successful management of patients with this pathology.

Keywords

Pulmonary angiosarcoma; Pulmonary embolism; Cardiopulmonary bypass; Pulmonary hypertension; Case report

Resumo

Introdução

Os angiossarcomas pulmonares pleomórficos primários são tumores extremamente raros que podem ser facilmente confundidos com êmbolos pulmonares.

Justificativa e achados

Descrevemos o manejo perioperatório bem-sucedido de um paciente com massa arterial pulmonar que se revelou um angiossarcoma pulmonar primário. A hipertensão pulmonar grave foi um desafio particular agravado pelo local e aderências do tumor e hemorragia pulmonar. O procedimento foi realizado com sucesso com controle hemodinâmico rigoroso, garantindo pressões arteriais sistêmicas e pulmonares estáveis, usando ecocardiografia transesofágica perioperatória para monitorar continuamente a função cardíaca, juntamente com outros monitores cirúrgicos cardíacos padrão, incluindo monitoramento da profundidade da anestesia.

Conclusão

O controle hemodinâmico rigoroso, a garantia de pressões arteriais pulmonares estáveis por meio da ecocardiografia perioperatória e o preparo minucioso com medidas para reduzir e prevenir o aumento da pressão arterial pulmonar, juntamente com a comunicação estreita dentro da equipe multidisciplinar são essenciais para o manejo bem-sucedido dos pacientes com essa patologia.

Palavras-chave

Angiossarcoma pulmonar; Embolia pulmonar; Circulação extracorpórea; Hipertensão pulmonar; Relato de caso

References

1. Mahajan A, Rekhi B, Laskar S, et al. Primary pulmonary artery sarcoma masquerading as pulmonary thromboembolism: a rare diagnosis unveiled. Clin Sarcoma Res. 2017;7:13.

2. Kerr KM. Pulmonary artery sarcoma masquerading as chronic thromboembolic pulmonary hypertension. Nat Clin Pract Cardiovasc Med. 2005;2:108–12.

3. Ozbek C, Emrecan B, Calli AO, et al. Intimal sarcoma of the pulmonary artery with retrograde extension into the pulmonic valve and right ventricle. Tex Heart Inst J. 2007;34:119–21.

4. Tachi K, Inomata S, Tanaka M. Occlusion of the pulmonary artery by a primary pulmonary artery sarcoma resulting in cardiac arrest: a case report. JA Clin Rep. 2019;5:15.

5. Chhaya NC, Goodwin AT, Jenkins DP, et al. Surgical treatment of pulmonary artery sarcoma. J Thorac Cardiovasc Surg. 2014;148:113–8.


Submitted date:
02/07/2021

Accepted date:
05/22/2021

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