Spinal cord ischemia resulting in paraplegia following extrapleural pneumonectomy

Chest. 2014 Aug;146(2):e38-e40. doi: 10.1378/chest.13-3062.


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.

Publication types

  • Case Reports

MeSH terms

  • Biopsy
  • Diagnosis, Differential
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / surgery*
  • Magnetic Resonance Imaging
  • Male
  • Mesothelioma / diagnosis
  • Mesothelioma / surgery*
  • Mesothelioma, Malignant
  • Middle Aged
  • Paraplegia / diagnosis
  • Paraplegia / etiology*
  • Pleural Neoplasms / diagnosis
  • Pleural Neoplasms / surgery*
  • Pneumonectomy / adverse effects*
  • Postoperative Complications
  • Spinal Cord Ischemia / complications*
  • Spinal Cord Ischemia / diagnosis
  • Thoracic Vertebrae
  • Tomography, X-Ray Computed