Se presenta el caso de un varón adulto de 56 años de edad diagnosticado de carcinoma epidermoide de pulmón derecho (T4 NO MO, estadio IIIb) tratado previamente mediante quimioterapia y radioterapia programado para neumonectomía derecha. Durante la misma se evidenció la necesidad de realizar cirugía extracorpórea para resección de infiltración tumoral en aurícula derecha. Durante la salida de bypass se produjo un deterioro hemodinámico brusco con mala respuesta a volumen e inotrópicos, diagnosticándose un síndrome de vena cava superior por tracción del tronco innominado debido a retractor quirúrgico, que cedió tras la retirada del mismo. Se discute la fisiopatología del cuadro y las consideraciones intraoperatorias del mismo.
A 56-year-old male diagnosed of epidermoid carcinoma of the right lung (T4 NO M0, stage IIIb) is described. He had earlier received chemotherapy and radiotherapy and was scheduled for removal of the right lung. During surgery the need to resect tumor infiltration of the right atrium became evident. During weaning from by-pass sudden deterioration of hemodynamics occurred with poor response to volume and inotropic drugs. Superior vena cava syndrome due to traction of the innominate trunk from a surgical retractor was diagnosed; the crisis resolved when the retractor was withdrawn. We discuss the pathophysiology of this clinical picture and relevant intraoperative aspects.
