2016 Volume 36 Issue 7 Pages 1243-1247
We encountered a case in which soluble fibrin monomer complex (SFMC) measurement in the plasma was useful for the diagnosis of perioperative critical pulmonary thromboembolism (PTE). A man in his 70s with a high fever and weakness of the limbs was referred to our hospital. Blood tests showed elevated levels of creatine phosphokinase. The patient was diagnosed as having an infection of unknown origin with rhabdomyolysis. Whole-body computed tomography (CT) revealed thickening of the wall of the ascending colon. Colonoscopy showed an elevated lesion in the ascending colon. Endoscopic biopsy specimens revealed the diagnosis of colonic adenocarcinoma. Based on these findings, a diagnosis of ascending colon cancer was made, and right hemicolectomy was scheduled. During induction of anesthesia for the surgery, the blood pressure and peripheral arterial oxygen saturation suddenly decreased. The surgery was, however, continued as the blood pressure and oxygen saturation improved with blood transfusion and catecholamine infusion. A blood test revealed elevation of the plasma SFMC level to 129.8μg/mL (reference value ≤7.0μg/mL), and acute pulmonary embolism was suspected. However, transesophageal echocardiography did not reveal either severe right ventricular hypokinesis or persistent pulmonary hypertension. Postoperative measurement revealed further elevation of the SFMC level (361.6μg/mL)；therefore, emergency CT was performed, which revealed pulmonary embolism and left femoral vein thrombosis. An inferior vena cava (IVC) filter was placed immediately. Anticoagulant therapy was started from the day after the surgery. The IVC filter was removed after 2 weeks, and the patient was discharged on day 31 after the operation. This case report indicates the usefulness of plasma SFMC measurement for early diagnosis of PTE in perioperative patients.
