PMC8557050_01
Low-dose lung CT demonstrated multiple right lung tumors (arrow).
CRINM2021-2232769.001.jpg
PMC8557050_01_CRINM2021-2232769.001.jpg
fig1
The patient is a 62-year-old male who has right lung cancer with multiple metastasis, cT4N2M1c, stage 4B (Figure 1), after radiotherapy and chemotherapy.
The patient presented spinal tumor at the T2 level with cord compression. (a) T2-weighted, (b) T1-weighted with a contrast sagittal view, and (c) T1-weighted with a contrast axial view.
CRINM2021-2232769.002.jpg
PMC8557050_01_CRINM2021-2232769.002.jpg
fig2
T2 vertebral body (Figure 2). The patient's symptoms were related to pathologic fracture which was caused by the T2 vertebral body and T2 left-side pedicle tumor invasion. Therefore, radiculopathy and bone pain were chief symptoms instead of myelopathy.
Intraoperative picture revealed the good decompression of the spinal cord.
CRINM2021-2232769.003.jpg
PMC8557050_01_CRINM2021-2232769.003.jpg
fig3
Unfortunately, after 2 hours of surgery, just as we had removed the laminae to get well decompression (Figure 3), put all of pedicle screws, and prepared to fix the pedicle screws, sudden-onset blood pressure drop from 110/80 to 75/50 occurred and heart rate elevated to 120 bpm.
Postop immediate CT revealed all screws had good position: (a) sagittal view, (b) T1 level screws, (c) T3 screws, and (d) T4 screws.
CRINM2021-2232769.004.jpg
PMC8557050_01_CRINM2021-2232769.004.jpg
fig4
In our urgent condition, an immediate CT scan was performed instead to evaluate the condition, which showed all pedicle screws well positioned (Figure 4).
Postop immediate CT showed right apical lung pneumothorax (star) and consolidation at the right lung, leading to the radiologist's suspicion of tumor or collapsed lung (triangle): (a) sagittal view; (b) lung window.
CRINM2021-2232769.005.jpg
PMC8557050_01_CRINM2021-2232769.005.jpg
fig5
The radiologist opined that there was no obvious compressive lesion around the spinal cord such as a hematoma or abscess between C1 and T9 but found right upper lung pneumothorax with obvious bullae (Figure 5).