Rescue surgery for massive pulmonary thromboembolism due to inferior vena cava tumor thrombus from renal leiomyosarcoma with preoperative veno-arterial extracorporeal membrane oxygenation support: a case report

Abstract Introduction Leiomyosarcoma is a rare malignant mesenchymal tumor that may contribute to the development of an inferior vena cava (IVC) tumor thrombus. Herein, we report a life-saving case of resection of a massive pulmonary thromboembolism (PTE) associated with an IVC tumor thrombus from renal leiomyosarcoma, performed under veno-arterial extracorporeal membrane oxygenation (V-A ECMO) circulation support. Case presentation A 72-year-old woman was transferred to the emergency department with dyspnea. Contrast-enhanced computed tomography (CT) detected a 53 mm large mass in the right kidney with an IVC tumor thrombus, right iliac vein thrombosis, and bilateral PTE. Although intravenous heparin infusion was initiated, V-A ECMO circulation support was also initiated because of circulatory collapse. A follow-up CT scan revealed no reduction in PTE. The multidisciplinary team concluded that the patient's critical condition could only be improved by addressing the right heart failure through thrombus removal, necessitating emergency surgical intervention to save the patient's life. Emergency surgery, including right nephrectomy, IVC tumor thrombectomy, and bilateral pulmonary artery thrombectomy, was performed under V-A ECMO using heparin. The final diagnosis was leiomyosarcoma with an IVC tumor thrombus and a fresh thrombus in the pulmonary artery. After 11 months of follow-up, the patient is alive with no clinical or radiological evidence of recurrence. Conclusion We experienced a life-saving resected case of massive PTE associated with IVC tumor thrombus of renal leiomyosarcoma under V-A ECMO circulation support.