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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

Renal pelvis of the right kidney was hemorrhagic and filled with sandy stones (A: at autopsy; B: after fixation).
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Figure 2: Renal pelvis of the right kidney was hemorrhagic and filled with sandy stones (A: at autopsy; B: after fixation).

Mentions: The left kidney weighted 200 g, with an appearance of cystiform dilatation and atrophy. Renal pelvis and the upper ureter were thickened and fibrotic. A 1.0 cm × 2.0 cm renal stone was found within the malformation of expandable sacs. The right kidney weighted 140 g. The renal pelvis was hemorrhagic and fulfilled with sandy stones (Figure 2). Perinephric hematoma and edema were formed around the right kidney. No hemorrhage was found in the ureters and pelvic cavity.


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

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

Renal pelvis of the right kidney was hemorrhagic and filled with sandy stones (A: at autopsy; B: after fixation).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Renal pelvis of the right kidney was hemorrhagic and filled with sandy stones (A: at autopsy; B: after fixation).
Mentions: The left kidney weighted 200 g, with an appearance of cystiform dilatation and atrophy. Renal pelvis and the upper ureter were thickened and fibrotic. A 1.0 cm × 2.0 cm renal stone was found within the malformation of expandable sacs. The right kidney weighted 140 g. The renal pelvis was hemorrhagic and fulfilled with sandy stones (Figure 2). Perinephric hematoma and edema were formed around the right kidney. No hemorrhage was found in the ureters and pelvic cavity.

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