{"title":"Fatal Air Embolism after Choroidal Melanoma Endoresection without Air Infusion: A Case Report.","authors":"Duangnate Rojanaporn, Boontip Tipsuriyaporn, Patnarin Chulalaksiriboon, Tanit Virankabutra, Sunthiti Morakul, Bertil Damato","doi":"10.1159/000518976","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to report 2 cases of pulmonary air embolism developing several hours after choroidal melanoma endoresection without the use of air infusion during the surgery, with fatality in 1 patient.</p><p><strong>Methods: </strong>The method of this study was case report.</p><p><strong>Participants: </strong>Two patients with large choroidal melanomas who collapsed several hours after endoresection without air infusion as a result of pulmonary air embolism.</p><p><strong>Results: </strong>A 72-year-old man collapsed 4 h and 30 min after endoresection without air infusion. Computerized tomography angiography confirmed air embolism. The patient died after 86 min of cardiopulmonary resuscitation. A 41-year-old woman collapsed 5 h and 30 min after endoresection, performed without air infusion and with close monitoring, which included right internal jugular vein catheterization intraoperatively. Transthoracic and transesophageal echography, performed preoperatively, intraoperatively, and postoperatively, revealed air embolism only after collapse occurred. Imaging showed the embolism to be biventricular because of patent foramen ovale. The patient was treated promptly with extracorporeal membrane oxygenation and mechanical ventilation, which resulted in a full recovery.</p><p><strong>Conclusions: </strong>Air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion. Further studies are needed to understand how this occurs. Special measures are indicated to detect this complication and to treat it promptly and effectively.</p>","PeriodicalId":19434,"journal":{"name":"Ocular Oncology and Pathology","volume":"7 5","pages":"321-325"},"PeriodicalIF":0.9000,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531826/pdf/oop-0007-0321.pdf","citationCount":"5","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ocular Oncology and Pathology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1159/000518976","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2021/8/13 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 5
Abstract
Background: The aim of this study was to report 2 cases of pulmonary air embolism developing several hours after choroidal melanoma endoresection without the use of air infusion during the surgery, with fatality in 1 patient.
Methods: The method of this study was case report.
Participants: Two patients with large choroidal melanomas who collapsed several hours after endoresection without air infusion as a result of pulmonary air embolism.
Results: A 72-year-old man collapsed 4 h and 30 min after endoresection without air infusion. Computerized tomography angiography confirmed air embolism. The patient died after 86 min of cardiopulmonary resuscitation. A 41-year-old woman collapsed 5 h and 30 min after endoresection, performed without air infusion and with close monitoring, which included right internal jugular vein catheterization intraoperatively. Transthoracic and transesophageal echography, performed preoperatively, intraoperatively, and postoperatively, revealed air embolism only after collapse occurred. Imaging showed the embolism to be biventricular because of patent foramen ovale. The patient was treated promptly with extracorporeal membrane oxygenation and mechanical ventilation, which resulted in a full recovery.
Conclusions: Air embolism can develop after endoresection for choroidal melanoma, despite avoiding air infusion. Further studies are needed to understand how this occurs. Special measures are indicated to detect this complication and to treat it promptly and effectively.
背景:本研究的目的是报告2例在脉络膜黑色素瘤内切术后数小时内发生肺空气栓塞，术中未使用空气输注，1例死亡。方法:采用病例报告法。参与者:两例大脉络膜黑素瘤患者，由于肺空气栓塞，在没有空气输注的情况下内镜切除数小时后塌陷。结果:1例72岁男性患者在内镜切除后4 h 30 min无空气输注后突然晕倒。计算机断层血管造影证实空气栓塞。患者经心肺复苏86分钟后死亡。1例41岁女性患者在内镜切除5 h 30 min后昏迷，术中无空气输注，严密监护，包括右颈内静脉置管。术前、术中及术后经胸、经食管超声检查显示，只有在发生虚脱后才有空气栓塞。影像学显示因卵圆孔未闭导致的栓塞为双心室栓塞。患者及时接受体外膜氧合和机械通气治疗，最终完全康复。结论:脉络膜黑色素瘤切除术后，尽管避免空气输注，仍可发生空气栓塞。需要进一步的研究来了解这是如何发生的。指出了特殊的措施，以发现这一并发症，并及时有效地治疗。
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