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Sudden unexpected death in a patient with tumour associated pulmonary embolism.

Laohachewin D, André F, Tschaharganeh D, Katus HA, Korosoglou G - Case Rep Med (2014)

Bottom Line: Tumour embolisms are rare and in most cases sudden causes of death.The patient had suspected Ormond's disease and no previous history of tumour burden.Possible diagnostic and treatment options are discussed herein and an overview of the current literature is also presented.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine III, Cardiology, Angiology, and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.

ABSTRACT
Tumour embolisms are rare and in most cases sudden causes of death. Diagnosing this rare condition is still very challenging in the daily clinical routine. In this report we present a case of a lethal sudden pulmonary tumour embolism in a 71-year-old male patient, who was admitted for elective invasive coronary angiography due to suspected coronary artery disease. The patient had suspected Ormond's disease and no previous history of tumour burden. Possible diagnostic and treatment options are discussed herein and an overview of the current literature is also presented.

No MeSH data available.


Related in: MedlinePlus

(a) Squamous cell carcinoma manifestation in the ureteral wall. (b) Metastatic manifestation of the squamous cell carcinoma lesion in the vertebral body. (c) Tumour infiltration of periurethral fat tissue. (d) Pulmonary vessels with extensive squamous cell carcinoma tumour embolisms and haemorrhagic infarction of the pulmonary parenchyma.
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fig2: (a) Squamous cell carcinoma manifestation in the ureteral wall. (b) Metastatic manifestation of the squamous cell carcinoma lesion in the vertebral body. (c) Tumour infiltration of periurethral fat tissue. (d) Pulmonary vessels with extensive squamous cell carcinoma tumour embolisms and haemorrhagic infarction of the pulmonary parenchyma.

Mentions: A 71-year-old patient was admitted to our department for elective coronary angiography due to suspected coronary artery disease. His main complaint was typical angina at moderate exertion (CCS class II). Additionally, he reported swelling in the scrotum and his right leg during the past 6 months. A deep vein thrombosis was ruled out by negative Doppler sonography. A computed tomography (CT) scan on the other hand showed diffuse proliferation of fibrous tissue in the retroperitoneum, compatible with Ormond's disease (Figure 1). Endoscopic evaluation demonstrated mild gastritis and duodenitis, without further malignant findings. Transthoracic echocardiography revealed preserved left ventricular function and a borderline increase of systolic pulmonary arterial pressure of 35 mmHg. Coronary angiography on the other hand revealed a 2-vessel coronary artery disease, with a 50% stenosis of the left main and mid right coronary artery. In this regard, absence of inducible myocardial ischemia was observed using cardiac dobutamine stress magnetic resonance tomography, and therefore PCI was not performed. In addition, a mild dilatation of the RV was noticed with baseline CMR images. During his hospital stay, however, the patient was found unconscious, centralized, and with apnoea, requiring immediate cardiopulmonary resuscitation and admission to our intensive care unit. Echocardiographic examinations revealed akinetic ventricles without pericardial effusion and ECG showed pulseless electrical activity. The patient expired despite prolonged resuscitation. Postmortem autopsy revealed an unexpected diagnosis. Thus, histopathologic work-up showed a squamous cell carcinoma of the right ureter (apT4, apN3, apM1, V1, G2), which infiltrated the pelvis, corresponding vessels, and periurethral tissue and caused metastatic lesions in the vertebral body (Figures 2(a)–2(c)). In addition, massive embolization of cell conglomerates was observed in the pulmonary vessels causing haemorrhagic infarction of the pulmonary parenchyma (Figure 2(d)).


Sudden unexpected death in a patient with tumour associated pulmonary embolism.

Laohachewin D, André F, Tschaharganeh D, Katus HA, Korosoglou G - Case Rep Med (2014)

(a) Squamous cell carcinoma manifestation in the ureteral wall. (b) Metastatic manifestation of the squamous cell carcinoma lesion in the vertebral body. (c) Tumour infiltration of periurethral fat tissue. (d) Pulmonary vessels with extensive squamous cell carcinoma tumour embolisms and haemorrhagic infarction of the pulmonary parenchyma.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4265546&req=5

fig2: (a) Squamous cell carcinoma manifestation in the ureteral wall. (b) Metastatic manifestation of the squamous cell carcinoma lesion in the vertebral body. (c) Tumour infiltration of periurethral fat tissue. (d) Pulmonary vessels with extensive squamous cell carcinoma tumour embolisms and haemorrhagic infarction of the pulmonary parenchyma.
Mentions: A 71-year-old patient was admitted to our department for elective coronary angiography due to suspected coronary artery disease. His main complaint was typical angina at moderate exertion (CCS class II). Additionally, he reported swelling in the scrotum and his right leg during the past 6 months. A deep vein thrombosis was ruled out by negative Doppler sonography. A computed tomography (CT) scan on the other hand showed diffuse proliferation of fibrous tissue in the retroperitoneum, compatible with Ormond's disease (Figure 1). Endoscopic evaluation demonstrated mild gastritis and duodenitis, without further malignant findings. Transthoracic echocardiography revealed preserved left ventricular function and a borderline increase of systolic pulmonary arterial pressure of 35 mmHg. Coronary angiography on the other hand revealed a 2-vessel coronary artery disease, with a 50% stenosis of the left main and mid right coronary artery. In this regard, absence of inducible myocardial ischemia was observed using cardiac dobutamine stress magnetic resonance tomography, and therefore PCI was not performed. In addition, a mild dilatation of the RV was noticed with baseline CMR images. During his hospital stay, however, the patient was found unconscious, centralized, and with apnoea, requiring immediate cardiopulmonary resuscitation and admission to our intensive care unit. Echocardiographic examinations revealed akinetic ventricles without pericardial effusion and ECG showed pulseless electrical activity. The patient expired despite prolonged resuscitation. Postmortem autopsy revealed an unexpected diagnosis. Thus, histopathologic work-up showed a squamous cell carcinoma of the right ureter (apT4, apN3, apM1, V1, G2), which infiltrated the pelvis, corresponding vessels, and periurethral tissue and caused metastatic lesions in the vertebral body (Figures 2(a)–2(c)). In addition, massive embolization of cell conglomerates was observed in the pulmonary vessels causing haemorrhagic infarction of the pulmonary parenchyma (Figure 2(d)).

Bottom Line: Tumour embolisms are rare and in most cases sudden causes of death.The patient had suspected Ormond's disease and no previous history of tumour burden.Possible diagnostic and treatment options are discussed herein and an overview of the current literature is also presented.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine III, Cardiology, Angiology, and Pulmonology, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany.

ABSTRACT
Tumour embolisms are rare and in most cases sudden causes of death. Diagnosing this rare condition is still very challenging in the daily clinical routine. In this report we present a case of a lethal sudden pulmonary tumour embolism in a 71-year-old male patient, who was admitted for elective invasive coronary angiography due to suspected coronary artery disease. The patient had suspected Ormond's disease and no previous history of tumour burden. Possible diagnostic and treatment options are discussed herein and an overview of the current literature is also presented.

No MeSH data available.


Related in: MedlinePlus