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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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Pulmonary emboli were formed by blue-purple particles (A: hematoxylin and eosin stain, ×40) and showed birefringent crystals characteristic (B: polarized light, ×40). Von Kossa staining proved the emboli to be calcium salt (C: Von Kossa stain, ×40).
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Figure 3: Pulmonary emboli were formed by blue-purple particles (A: hematoxylin and eosin stain, ×40) and showed birefringent crystals characteristic (B: polarized light, ×40). Von Kossa staining proved the emboli to be calcium salt (C: Von Kossa stain, ×40).

Mentions: Her lungs revealed scattered alveolar hemorrhage, pulmonary edema, mild thickness and hyaline degeneration of pulmonary arterioles, and inflammatory cells scattered increasingly within the pulmonary vessels. Photomicrograph of hematoxylin and eosin staining showed emboli were formed by blue-purple particles (Figure 3A), which exhibited birefringent crystals characteristic under polarized light (Figure 3B). Von Kossa staining proved the emboli to be calcium salt (Figure 3C).


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

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

Pulmonary emboli were formed by blue-purple particles (A: hematoxylin and eosin stain, ×40) and showed birefringent crystals characteristic (B: polarized light, ×40). Von Kossa staining proved the emboli to be calcium salt (C: Von Kossa stain, ×40).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Pulmonary emboli were formed by blue-purple particles (A: hematoxylin and eosin stain, ×40) and showed birefringent crystals characteristic (B: polarized light, ×40). Von Kossa staining proved the emboli to be calcium salt (C: Von Kossa stain, ×40).
Mentions: Her lungs revealed scattered alveolar hemorrhage, pulmonary edema, mild thickness and hyaline degeneration of pulmonary arterioles, and inflammatory cells scattered increasingly within the pulmonary vessels. Photomicrograph of hematoxylin and eosin staining showed emboli were formed by blue-purple particles (Figure 3A), which exhibited birefringent crystals characteristic under polarized light (Figure 3B). Von Kossa staining proved the emboli to be calcium salt (Figure 3C).

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