Metastatic leiomyosarcoma presenting as a lung mass with left atrial extension: case report and anesthetic management

Figures & data

Figure 1 Preoperative and postoperative chest X-ray of the patient.

Notes: (A) Posterior–anterior chest X-ray preoperatively showing pulmonary edema and a mass in the left lung. (B) Chest X-ray 3 h postoperatively showing pulmonary edema was relieved, and the lung mass became distinct.

Figure 2 Hyperechoic lumpy mass detected on transthoracic echocardiography.

Note: Apical four chamber view showing the mass in the left atrium (orange arrow).

Table 1 Arterial blood gas analysis and ACT during surgery

Time point	After intubation	Before CPB	CPB 40 min	CPB 85 min	After CPB
pH	7.39	7.43	7.50	7.55	7.42
PaO2 (mmHg)	57	48	313	453	68
PaCO2 (mmHg)	49	44	36	35	41
BE (mEq/L)	3.2	3.9	3.9	6.8	0.9
Hb (g/L)	103	87	88	100	89
ACT (s)	118	489	496	592	134

Abbreviations: ACT, activated clotting time; BE, base excess; CPB, cardiopulmonary bypass; Hb, hemoglobin; PaCO₂, partial pressure of carbon dioxide in artery; PaO₂, partial pressure of oxygen in artery.

Table 2 Vital signs and ventilation parameters during surgery

Time point	Preoperative	After intubation	Adjustment	After CPB	Extubation	Recovery
HR (bpm)	111	120	125	110	110	72
ABP (mmHg)	121/82	110/58	120/69	110/70	110/71	121/72
SpO2 (%)	92	90	94	93	95	95
Airway peak pressure (cmH2O)	–	28	24	25	–	–
PEEP (cmH2O)	–	–	6	6	–	–

Abbreviations: ABP, arterial blood pressure; CPB, cardiopulmonary bypass; HR, heart rate; PEEP, positive end expiratory pressure; SpO₂, pulse oximetry.

Figure 3 Timeline of interventions and outcomes.

Abbreviations: ABP, arterial blood pressure; CPB, cardiopulmonary bypass; CVP, central venous pressure; CXR, chest X-ray; DOS, day of surgery; ECG, electrocardiogram; ICU, intensive care unit; PASP, pulmonary arterial systolic pressure; PEEP, positive end expiratory pressure; POD, postoperative day; TTE, transthoracic echocardiography; SpO₂, pulse oximetry.