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Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy: A Case Report.

Zhang L, Zhou Y - Medicine (Baltimore) (2015)

Bottom Line: An autopsy did not reveal any evidence of pulmonary embolism.However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis.The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation.

View Article: PubMed Central - PubMed

Affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.

ABSTRACT
Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before.We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output.This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism.

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Related in: MedlinePlus

Intravenous pyelography showed caliceal stones in the right kidney and the middle of the left ureter, and hydronephrosis of both kidneys.
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Figure 1: Intravenous pyelography showed caliceal stones in the right kidney and the middle of the left ureter, and hydronephrosis of both kidneys.

Mentions: The patient was a 50-year-old woman admitted to the hospital because of pain in the waist and back, with nausea and vomiting for approximately 1 day. Her medical record showed she had hypertension with the peak value of 160/100 mm Hg. A physical examination indicated the following: blood pressure of 143/95 mm Hg, normal heart and respiratory rate, normal temperature, and percussion pain in the kidney area. Electrocardiogram and chest film indicated no abnormality. B type-ultrasound abdominal plain film and intravenous pyelography revealed hydronephrosis of both kidneys and multiple caliceal stones, including the biggest one of a size of 2.0 cm × 1.2 cm in the right kidney and a 1.0 cm × 1.2 cm in the middle of the left ureter (Figure 1).


Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy: A Case Report.

Zhang L, Zhou Y - Medicine (Baltimore) (2015)

Intravenous pyelography showed caliceal stones in the right kidney and the middle of the left ureter, and hydronephrosis of both kidneys.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554109&req=5

Figure 1: Intravenous pyelography showed caliceal stones in the right kidney and the middle of the left ureter, and hydronephrosis of both kidneys.
Mentions: The patient was a 50-year-old woman admitted to the hospital because of pain in the waist and back, with nausea and vomiting for approximately 1 day. Her medical record showed she had hypertension with the peak value of 160/100 mm Hg. A physical examination indicated the following: blood pressure of 143/95 mm Hg, normal heart and respiratory rate, normal temperature, and percussion pain in the kidney area. Electrocardiogram and chest film indicated no abnormality. B type-ultrasound abdominal plain film and intravenous pyelography revealed hydronephrosis of both kidneys and multiple caliceal stones, including the biggest one of a size of 2.0 cm × 1.2 cm in the right kidney and a 1.0 cm × 1.2 cm in the middle of the left ureter (Figure 1).

Bottom Line: An autopsy did not reveal any evidence of pulmonary embolism.However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis.The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation.

View Article: PubMed Central - PubMed

Affiliation: Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China.

ABSTRACT
Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before.We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output.This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism.

Show MeSH
Related in: MedlinePlus