Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Jul 20:45:101896.
doi: 10.1016/j.rmcr.2023.101896. eCollection 2023.

A case of pulmonary tumor embolism syndrome with thrombus in transit

Alexandra Fuher  1 , Esther de Boer  1 , Peter Hountras  1
Affiliations
Case Reports

A case of pulmonary tumor embolism syndrome with thrombus in transit

Alexandra Fuher et al. Respir Med Case Rep. .

Abstract

The incidence of pulmonary tumor embolism in patients with solid tumors is estimated to be between 3% and 26% yet is rarely diagnosed. In this case, a 74-year-old male with sarcomatoid variant of urothelial carcinoma and recently diagnosed left renal vein thrombus treated with low-molecular-weight-heparin, presented to the emergency department with acute syncope and dyspnea. He was found to have CT imaging of segmental and subsegmental arterial filling defects, a right atrial filling defect concerning for thrombus in transit and was diagnosed with pulmonary tumor embolism syndrome. The patient was treated with aspiration thrombectomy, with pathology demonstrating sarcomatoid urothelial carcinoma cells. He was initiated on a combination of gemcitabine plus carboplatin to decrease the tumor burden. While pulmonary tumor embolism syndrome is associated with a poor prognosis, prompt diagnosis and initiation of cancer-specific therapies can significantly improve survival.

Keywords: Percutaneous aspiration thrombectomy; Pulmonary tumor embolism syndrome; Pulmonary vascular disease.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
– Mobile right atrial thrombus (marked by asterisk) traversing into the right ventricle.
Fig. 2
Fig. 2
– (a-b) Postprocedure removal of right atrial thrombus. (c) Diffuse sheets of sarcomatoid urothelial carcinoma cells (arrow). (d) Tumor cells with diffuse positive immunostaining for carbonic anhydrase IX (arrowhead) a urinary marker for bladder cancer and (e) AE1/AE3 cytokeratin (arrowhead) stains. Scale bar = 200um.
See this image and copyright information in PMC

References

    1. Reynolds M.W., Shibata A., Zhao S., et al. Impact of clinical trial design and execution-related factors on incidence of thromboembolic events in cancer patients: a systematic review and meta-analysis. Curr. Med. Res. Opin. 2008;24(2):597–598. - PubMed
    1. Gruber M., Bull T.M. In: Clinical Respiratory Medicine. fourth ed. Spiro S.G., editor. WB Saunders; Philadelphia: 2012. Chapter 57: pulmonary embolism; pp. 690–709.
    1. Hountras P., Bull T.M. Advanced therapies for pulmonary embolism. Curr. Opin. Pulm. Med. 2020 Sep;26(5):397–405. - PubMed
    1. Ori C., Carron M. Thrombolysis for massive pulmonary tumour embolism in a patient with cavoatrial renal carcinoma. Br. J. Anaesth. 2008;101(2):285–286. - PubMed
    1. Orgeron G.M., Pollard J.L., Pourmalek P., Sloane P.J. Catheter-directed low dose tissue plasminogen activator for treatment of right atrial thrombus caused by a central venous catheter. Pharmacotherapy. 2015;35(10):e153–e158. - PubMed

Publication types

LinkOut - more resources