Malignant pulmonary embolism associated with renal sarcoma A case report

Abstract

Rationale: The preoperative diagnosis of massive pulmonary tumor embolism associated with renal neoplasms is relatively rare. In most cases, pulmonary tumor embolism is detected intraoperatively during renal tumor resection. Moreover, primary renal sarcoma is rare, and primary renal sarcoma complicated by pulmonary tumor embolism is extremely rare; accordingly, there is no optimal treatment for such cases. Herein, we report a case of renal sarcoma associated with pulmonary tumor embolism. Patient concerns: A 39-year-old man was admitted to the emergency room owing to the sudden onset of dyspnea and palpitation. Diagnosis: Contrast-enhanced computed tomography (CT) revealed a large mass in the right kidney involving the infrahepatic inferior vena cava, with massive pulmonary emboli in both the pulmonary arteries. Interventions: Emergency pulmonary embolectomy with radical nephrectomy was performed. Outcomes: The patient experienced apparent remission of dyspnea, and resolution of right ventricle dysfunction. However, although remnant emboli were detected in the segmental arteries on postoperative CT, complete resolution of pulmonary embolism was observed after adjuvant chemotherapy. Lessons: Thus, concomitant cytoreductive nephrectomy with pulmonary embolectomy along with chemotherapy may be effective for patients with renal sarcoma with pulmonary tumor embolism.