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Spinal Cord Ischemia Resulting in Paraplegia Following Extrapleural PneumonectomyParaplegia Following Extrapleural Pneumonectomy

Kelly Ural, MD; Kyle Jakob, MD; Scott Lato, MD; George Gilly, MD; Rodney Landreneau, MD
Author and Funding Information

From the Departments of Anesthesiology (Drs Ural, Lato, and Gilly) and Surgery (Drs Jakob and Landreneau), Ochsner Health System, New Orleans, LA.

CORRESPONDENCE TO: Kelly Ural, MD, Department of Anesthesiology, Ochsner Health System, 1514 Jefferson Hwy, New Orleans, LA 70121; e-mail: kural@ochsner.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(2):e38-e40. doi:10.1378/chest.13-3062
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A patient undergoing radical extrapleural pneumonectomy for epithelioid malignant mesothelioma developed acute paraplegia postoperatively related to long-segment spinal cord ischemia. The usual area of concern for this complication is the T9 to T12 area where the artery of Adamkiewicz is most likely to originate. In this patient, there was ligation of only upper thoracic, ipsilateral segmental arteries from the T3 to T6 level, yet he still developed paraplegia. Our hypothesis is variant mid-thoracic vascular anatomy. Previously unreported, to our knowledge, this should be understood as a rare complication of this surgery.

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