Obstructive Shock Due to a Crushed Left Atrium and Pulmonary Vein by Pulmonary Artery Intimal Sarcoma Successfully Treated with Pulmonary Vein Stenting

• Published in: Internal Medicine Vol. 63; no. 2; pp. 247 - 252
• Main Authors: Furukawa, Shoichiro, Inanaga, Keita, Osaki, Toshihiro, Yasuda, Manabu, Ohga, Yasuhiro, Ohishi, Yoshihiro, Matsumoto, Takashi, Uchida, Takayuki, Inoue, Shujiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.01.2024; Japan Science and Technology Agency
• Subjects: Case Report; Compression; Heart Failure; Humans; Hypoxemia; Male; Mediastinum; Middle Aged; Neoplasm Recurrence, Local; obstructive shock; postpneumonectomy; Pulmonary artery; Pulmonary Artery - diagnostic imaging; Pulmonary Artery - surgery; pulmonary artery intimal sarcoma; pulmonary vein stenosis; pulmonary vein stenting; Pulmonary Veins - surgery; Sarcoma; Sarcoma - complications; Sarcoma - surgery; Stenosis; venoarterial extracorporeal membrane oxygenation; obstructive shock; pulmonary artery intimal sarcoma; pulmonary vein stenting; postpneumonectomy; venoarterial extracorporeal membrane oxygenation; pulmonary vein stenosis
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.1487-22

A 46-year-old patient who had undergone right pneumonectomy for pulmonary artery intimal sarcoma presented with hypoxemia. The recurrent sarcoma in the mediastinum revealed external compression to the left pulmonary veins (PVs), leading to obstructive shock and cardiac arrest. Venous artery extracorporeal membrane oxygenation (VA-ECMO) was initiated; however, withdrawal was difficult, and the patient's survival seemed hopeless. However, the patient's condition improved with stenting for the compressed PV; therefore, VA-ECMO was discontinued, and he was discharged on foot. This is the first case report of obstructive shock due to critical PV stenosis caused by compression of a malignant tumor that responded to PV stenting.