A Case of Acute Pulmonary Embolism after Esophagectomy Effectively Treated by Thrombolysis with Tissue-type Plasminogen Activator

Motohito Nakagawa, Makoto Sano, Koichi Aiura, Yoshito Arisawa, Seiichiro Ishii, Kenji Matsumoto, Isao Yokoyama, Katsuhiko Noga

Department of Surgery, Kawasaki City Hospital

A case of acute pulmonary embolism after esophagectomy effectively treated by thrombolysis with a tissue-type plasminogen activator is reported. A 68-year-old male postoperative patient with esophageal cancer suddenly developed severe shortness of breath with anxiety. He had had a total thoracic esophagectomy under right thoracotomy and a gastric tube reconstruction 3 days earlier. Arterial blood gas analysis revealed a PaO₂ of 65 mmHg and a PaCO₂, of 39 mmHg (FiO₂, 1.0). Acute pulmonary embolism was diagnosed by emergency pulmonary arteriography on the basis of the defect of blood flow in the right upper lobe branch. Thrombolytic therapy with a human recombinant tissue-type plasminogen activator (rt-PA) was performed. Arterial blood gas data were dramatically improved (PaO₂ 180, PaCO₂, 38, FiO₂, 1.0) . In spite of the use of thrombolytic agents for postoperative pulmonary embolism, no side effects including bleeding tendency were observed. A pulmonary arteriography 23 days after the treatment showed markedly improved flow with complete dissolution of the clot. The diagnosis of pulmonary embolism after esophagectomy is difficult because of its nonspecific symptomatology which is similar to that of other usual postoperative respiratory complications. It is important to diagnose it definitively by pulmonary arteriography and treat it rapidly by thrombolytic therapy. Our experience suggests that rt-PA is an effective and safe agent for the treatment of postoperative acute pulmonary embolism.

Key words
acute pulmonary embolism, recombinant tissue-type plasminogen activator, postoperative complication after esophagectomy

Reprint requests
Motohito Nakagawa Department of Surgery, Kawasaki City Hospital
12-1 Shinkawadori, Kawasaki-ku, Kawasaki, 221 JAPAN

Accepted
December 7, 1994

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