use of transesophageal echocardiography during cesarean section in a parturient with inferior vena cava thrombosis a case report

1. Abstract 1.1. Introduction: The use of transesophageal echocardiography in obstetric anesthesia is uncommon and rarely reported during cesarean section. To our knowledge, this is the first report of its use for intraoperative surveillance of a tumor thrombus that has invaded over 90% of the inferior vena cava and was at risk of embolizing in a patient undergoing a cesarean section. 1.2. Case Presentation: We present at 16-year-old Hispanic female at 37 weeks of pregnancy who presented to us for higher level of care due to a newly discovered large left renal mass and inferior vena cava tumor thrombus. She successfully underwent general anesthesia with the assistance of transesophageal echocardiography for her cesarean section. 1.3. Conclusion : We used transesophageal echocardiography to directly observe the inferior vena cava tumor thrombus which would allow for an early intervention and to potentially avoid impending cardiovascular collapse. After a review of the available literature, this is the first case report to utilize transesophageal echocardiography to monitor a tumor thrombus in the setting of a cesarean section and large renal mass. Given the broad differential diagnosis if sudden cardiovascular collapse should occur, the use of transesophageal echocardiography provides the anesthesiologist a reliable and accurate assessment tool for quick management. 2. Keywords: Cesarean Section; Ewing’s Sarcoma; Inferior Vena Cava Thrombosis; Transesophageal Echocardiography