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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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ESEM-EDAX confirmed the same compositions of calcium, phosphorus, oxygen, and carbon in the crystals obtained both from the pulmonary small vessels.
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Figure 4: ESEM-EDAX confirmed the same compositions of calcium, phosphorus, oxygen, and carbon in the crystals obtained both from the pulmonary small vessels.

Mentions: Lungs and kidneys were fixed with 4% glutaraldehyde following autopsy. After vacuum drying and platinum coating, tissue sections were examined with an ESEM (FEI, Quanta 200, Holland) using an integrated energy dispersive X-ray spectrometer XRF-EDS (EDAX system, Mahwah, NJ). The foci of different transparency (spots) were visualized at higher magnification (200× or 1500×) and analyzed with the EDX mode to identify the chemical composition. ESEM-EDAX confirmed the same compositions of calcium, phosphorus, oxygen, and carbon in the crystals obtained from pulmonary arteries and capillaries and the right kidney (Figure 4).


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

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

ESEM-EDAX confirmed the same compositions of calcium, phosphorus, oxygen, and carbon in the crystals obtained both from the pulmonary small vessels.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: ESEM-EDAX confirmed the same compositions of calcium, phosphorus, oxygen, and carbon in the crystals obtained both from the pulmonary small vessels.
Mentions: Lungs and kidneys were fixed with 4% glutaraldehyde following autopsy. After vacuum drying and platinum coating, tissue sections were examined with an ESEM (FEI, Quanta 200, Holland) using an integrated energy dispersive X-ray spectrometer XRF-EDS (EDAX system, Mahwah, NJ). The foci of different transparency (spots) were visualized at higher magnification (200× or 1500×) and analyzed with the EDX mode to identify the chemical composition. ESEM-EDAX confirmed the same compositions of calcium, phosphorus, oxygen, and carbon in the crystals obtained from pulmonary arteries and capillaries and the right kidney (Figure 4).

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