RESUMEN
We have presented a rare case of pulmonary tumor microemboli from adenocarcinoma of the colon. The majority of primary tumors are adenocarcinomas, with gastric, breast, and liver carcinomas most frequently identified. Dyspnea and respiratory distress without an obvious cause is common. The history, physical examination, chest roentgenogram, ventilation-perfusion lung scan, and pulmonary angiogram are often not helpful in establishing the diagnosis. Pulmonary hypertension, present in our patient, and cor pulmonale are well described in association with diffuse pulmonary tumor microemboli. The pathologic findings are limited to the intravascular compartment exclusively, frequently in association with thrombus. The true incidence of pulmonary tumor microemboli is not known and may be underestimated. Appropriate management requires a high index of suspicion to establish the diagnosis.
Asunto(s)
Adenocarcinoma Papilar/complicaciones , Neoplasias del Colon/complicaciones , Células Neoplásicas Circulantes , Embolia Pulmonar/diagnóstico por imagen , Femenino , Humanos , Persona de Mediana Edad , Células Neoplásicas Circulantes/patología , Embolia Pulmonar/etiología , Embolia Pulmonar/patología , RadiografíaRESUMEN
Because lateral position can be used to locate a pulmonary artery catheter tip in lung regions where venous pressure exceeds alveolar pressure, we studied the effect of lateral position on the correlation between pulmonary artery occlusion pressure (Pw) and left atrial pressure (Pla) at various increments of positive-end expiratory pressure (PEEP). In ten normal anesthetized pigs, catheters were placed in the left atrium and right and left pulmonary arteries; simultaneous measurements of Pla and Pw from both catheters were obtained in the supine, right lateral, and left lateral positions. Pw obtained in the lateral position when the catheter tip was vertically located below the left atrium ("lower") more accurately reflected Pla changes than Pw obtained from catheters above the left atrium, at PEEP levels less than 20 cm H2O. Although most catheter tips were located below the left atrium in the supine position, our data from the lower catheter more accurately assessed Pla than did the Pw obtained in the supine position; this was particularly evident when the catheter tip was located vertically above the left atrium. These findings suggest that the lateral position can be useful in measuring Pw during continuous positive-pressure ventilation. However, further studies in humans are needed before this maneuver can be recommended.