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Washington University Experience | NEOPLASMS (MENINGIOMA) | Gross Pathology | 30A0 Case 30 History
Case 30 History ---- This patient was admitted for evaluation of a left breast mass present for 3-4 months. She also had right-sided headaches and forgetfulness for the past 6 months. A CT of the head showed a right frontal mass with homogeneous contrast enhancement and right to left shift most consistent with a sphenoid wing meningioma. The patient was started on Decadron on day 9. She underwent right frontoparietal craniotomy. At the beginning of the procedure, the right external carotid artery was ligated. The tumor was attached along the lateral Sylvian fissure to the anterior clinoid. The right middle cerebral artery was in the medial posterior part of the tumor capsule and was adherent. The tumor also extended beneath the tentorium and displaced the second and third cranial nerves. The bulk of the tumor was removed without any apparent damage to vessels. Immediately post/operatively, the patient had a right gaze preference and a dense left hemiparesis. There was a small clot in the tumor bed, but it was not felt to be under pressure. The dense left hemiparesis and partial right third nerve palsy persisted. An E. Coli urinary tract infection was treated with Septra. On June 7, the patient was sitting up eating dinner when she became acutely short of breath. Within two minutes there were no respirations and no pulse. Despite aggressive pulmonary resuscitation, no vital signs could be restored, and the patient was pronounced dead. ---- At autopsy the cause of her sudden demise was massive bilateral pulmonary thromboemboli with complete occlusion of right and left main pulmonary arteries.
