Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Newkirk, Lee; Vater, Youri; Oxorn, Donald C.; Mulligan, Michael S.; Conrad, Ernest U.

doi:10.1007/bf03018733

Cited by 18 publications

(22 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Previous reports describe anticoagulant treatment for deep venous thrombosis and pulmonary thromboembolism before tumor thrombus was correctly diagnosed [6, 9, 30, 31]. This also occurred in our patient in Fig.…”

Section: Discussionsupporting

confidence: 75%

Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

et al. 2015

View full text Add to dashboard Cite

Background Although hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. The enhanced resolution of modern CT and MRI scanners may lead to better detection of cardiovascular involvement. Objective To describe the key imaging findings and clinical behavior of cardiovascular involvement by osteosarcoma. Materials and methods We retrospectively reviewed the imaging findings and clinical characteristics of 20 patients with cardiovascular involvement by osteosarcoma identified by two pediatric radiologists from a review of imaging studies at our institution from 2007 to 2013. Results At initial diagnosis, the median age of the patients was 15.1 years (range 4.8–24.6 years), and 7 (35%) patients had detectable metastases. Median time to detection of cardiovascular metastases was 1.8 years (range 0–7.3 years). Sixteen patients died of disease; 4 have survived a median of 7.4 years since initial diagnosis. The sites of cardiovascular involvement were the systemic veins draining the primary and metastatic osteosarcoma, pulmonary arteries, pulmonary veins draining the pulmonary metastases, and heart. A dilated and mineralized terminal pulmonary arteriole is an early sign of metastatic osteosarcoma in the lung. Unfamiliarity with the imaging features resulted in under-recognition and misinterpretation of intravascular tumor thrombus as bland thrombus. Conclusion Knowledge of imaging findings in the era of modern imaging modalities has enhanced our ability to detect cardiovascular involvement and lung metastases early and avoid misinterpreting tumor thrombus in draining systemic veins or pulmonary arteries as bland thrombus.

show abstract

Section: Discussionsupporting

confidence: 75%

Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Moreover, we speculated that the real incidence of VTT in pelvic osteosarcoma could be higher because we only included cases undergone surgeries in this study. Those nonsurgically treated cases were generally more advanced and might have a higher chance to develop VTTs …”

Section: Discussionmentioning

confidence: 99%

“…Venous tumor thrombus (VTT) is not uncommonly seen in some retroperitoneal malignancies such as renal cell carcinoma and is occasionally noted as a rare condition in patients with osteosarcoma according to the previous literature . Almost all of the literal records about VTT in osteosarcoma were case reports with extremely poor outcomes and the pelvic ring was the most common location of those cases …”

Section: Introductionmentioning

confidence: 99%

“…Pelvic osteosarcomas accounted for only <10% of all osteosarcomas and their outcomes remained disappointing despite aggressive chemotherapy and surgery, with 5‐year overall survival (OS) ranging from 18% to 45% . The outcome would be much worse when a pelvic osteosarcoma was complicated by VTT and then a treatment dilemma would be encountered . Moreover, an unanticipated VTT found during operation would tremendously increase the risk of perioperative mortality and repudiate the significance of invasive resection of the tumor due to the compromised margin within the vessel .…”

Section: Introductionmentioning

confidence: 99%

“…Venous tumor thrombus (VTT) is not uncommonly seen in some retroperitoneal malignancies such as renal cell carcinoma 1 and is occasionally noted as a rare condition in patients with osteosarcoma according to the previous literature. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Almost all of the literal records about VTT in osteosarcoma were case reports with extremely poor outcomes and the pelvic ring was the most common location of those cases. 1,4,[6][7][8][9]11,13 Pelvic osteosarcomas accounted for only <10% of all osteosarcomas and their outcomes remained disappointing despite aggressive chemotherapy and surgery, with 5-year overall survival (OS) ranging from 18% to 45%.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: A mono‐institutional retrospective study of 115 cases

Liang

Yang

et al. 2018

Cancer Medicine

View full text Add to dashboard Cite

BackgroundVenous tumor thrombus (VTT) in pelvic osteosarcoma has been regarded as a rare oncological condition and few literatures investigated this issue.MethodsWe retrospectively reviewed 115 cases of pelvic osteosarcoma treated in our center from 2006 to 2016. Diagnosis of VTTs was made based on histo‐pathological findings. We summarized the radiological manifestations of VTTs on CT, MRI, and PET/CT. We also compared the demographical, oncological, and radiological data between cases with or without VTTs to identify its predisposing factors.ResultsSeventeen cases (14.8%) were diagnosed with VTT. Manifestations of VTTs on CT included increased caliber (64.7%), calcification (47.1%), low density on plain scan (100%), filling defect (100%), and streak‐like enhancement (35.7%) on contrast enhancement. On MRI, the VTTs could be hypo‐ or iso‐intense on T1WI (100%), hyperintense on T2WI (100%), and filling defect on contrast enhancement (100%). PET/CT showed high metabolic activity of the VTTs. The ranges of the VTTs included unilateral external iliac vein (EIV) (two cases), unilateral internal iliac vein (IIV) (one case), unilateral common iliac vein (CIV) and IIV (five cases), unilateral CIV + EIV (two cases), inferior vena cava (IVC) and unilateral CIV + EIV (one case), IVC and unilateral CIV + IIV (four cases), IVC and bilateral CIVs + IIVs (two cases). Multivariate analysis indicated that chondroblastic subtype and involvement of L5/S1 intervertebral foramen might predispose to VTTs.ConclusionThe incidence of VTTs in pelvic osteosarcoma was 14.8%. Comprehensive radiological studies help preoperative diagnosis of VTTs. Predisposing factors included chondroblasic subtype and involvement of L5/S1 intervertebral foramen.

show abstract

Role of anticoagulation in the management of tumor thrombus: A 10‐year single‐center experience

Agarwal

Mullikin

Scheurer

et al. 2021

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Background: Children with cancer diagnosis are overall at a higher risk of thrombosis.For a newly diagnosed blood clot, patients are commonly started on anticoagulants to prevent further extension and embolization of the clot. In the rare instance that a pediatric patient has a tumor thrombus, role of anticoagulation is less clear.Procedure/methods: Patients under 21 years of age with a finding of tumor thrombus on imaging from 2010 to 2020 at Texas Children's Hospital were identified and their medical records were reviewed.Results: A total of 50 patients were identified. Most thrombi were incidental findings at diagnosis; however, two patients presented with pulmonary embolism (PE).Inferior vena cava extension was noted in 36% of the patients, and 24% patients had an intracardiac tumor thrombus. Anticoagulation was initiated in 10 patients (20%).There was no difference in the rate of bland thrombus formation and/or embolization in patients who did or did not receive anticoagulation. However, three of the six patients with asymptomatic tumor thrombus who were started on anticoagulation had bleeding complications compared to only two patients in the no anticoagulation cohort (p < .05). Conclusion:Children with intravascular extension of solid tumors were not commonly started on anticoagulation at the time of diagnosis, irrespective of the extent of tumor thrombus. Furthermore, we observed a significant trend toward higher incidence of bleeding complications after initiation of anticoagulation for asymptomatic tumor thrombus. There is inadequate evidence at this time to support routine initiation of anticoagulation in pediatric patients with intravascular extension of solid tumors.

show abstract

Intraoperative TEE for the management of pulmonary tumour embolism during chondroblastic osteosarcoma resection

Cited by 18 publications

References 30 publications

Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: A mono‐institutional retrospective study of 115 cases

Role of anticoagulation in the management of tumor thrombus: A 10‐year single‐center experience

Contact Info

Product

Resources

About