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Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit
Patient: Female, 58-year-old Final Diagnosis: Tumor embolism Symptoms: Dyspnea Medication:— Clinical Procedure: Percutaneous embolectomy • surgical embolectomy Specialty: Cardiac surgery • Cardiology • Critical Care Medicine • Oncology OBJECTIVE: Rare disease BACKGROUND: Tumor embolism is a rare neo...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Scientific Literature, Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209904/ https://www.ncbi.nlm.nih.gov/pubmed/32345956 http://dx.doi.org/10.12659/AJCR.921124 |
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author | Rosenfeld, Benjamin L. Bashir, Riyaz Brisco-Bacik, Meredith A. Panidis, Ioannis P. Vaidya, Anjali Minakata, Kenji Forfia, Paul R. |
author_facet | Rosenfeld, Benjamin L. Bashir, Riyaz Brisco-Bacik, Meredith A. Panidis, Ioannis P. Vaidya, Anjali Minakata, Kenji Forfia, Paul R. |
author_sort | Rosenfeld, Benjamin L. |
collection | PubMed |
description | Patient: Female, 58-year-old Final Diagnosis: Tumor embolism Symptoms: Dyspnea Medication:— Clinical Procedure: Percutaneous embolectomy • surgical embolectomy Specialty: Cardiac surgery • Cardiology • Critical Care Medicine • Oncology OBJECTIVE: Rare disease BACKGROUND: Tumor embolism is a rare neoplastic complication that occurs when there is intravenous invasion by a benign or malignant tumor. We present the case of an asymptomatic patient with an incidentally discovered leiomyosarcoma tumor emboli, which was initially misdiagnosed as “thrombus in transit.” CASE REPORT: The patient was a 58-year-old woman who was incidentally found on echocardiogram to have a large tubular mass within the inferior vena cava and right atrium. Although initially characterized as “thrombus in transit”, this mobile right atrial mass was present without clinical, echocardiographic, or radiographic evidence of pulmonary embolism or increased pulmonary arterial impedance. Given that a thrombus in transit is nearly always associated with submassive or massive pulmonary emboli and their attendant right heart sequelae, these pertinent negative findings led us to seek an alternative diagnosis. After a trial of conservative management with anticoagulation and attempted removal of the mass with the AngioVac system, the patient ultimately underwent median sternotomy and surgical embolectomy on cardiopulmonary bypass to remove the mass, which was later identified on pathology as a leiomyosarcoma. CONCLUSIONS: With rare exceptions, “thrombus in transit” is accompanied by large pulmonary emboli and the presence of increased pulmonary artery pressure and right heart strain. The absence of clinical, echocardiographic, or radio-graphic evidence of these hemodynamic sequelae should raise suspicion for an alternative diagnosis. Tumor embolism should be considered in the differential diagnosis of any patient with a history of malignancy who presents with evidence of intracardiac mass or embolism. |
format | Online Article Text |
id | pubmed-7209904 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | International Scientific Literature, Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-72099042020-05-11 Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit Rosenfeld, Benjamin L. Bashir, Riyaz Brisco-Bacik, Meredith A. Panidis, Ioannis P. Vaidya, Anjali Minakata, Kenji Forfia, Paul R. Am J Case Rep Articles Patient: Female, 58-year-old Final Diagnosis: Tumor embolism Symptoms: Dyspnea Medication:— Clinical Procedure: Percutaneous embolectomy • surgical embolectomy Specialty: Cardiac surgery • Cardiology • Critical Care Medicine • Oncology OBJECTIVE: Rare disease BACKGROUND: Tumor embolism is a rare neoplastic complication that occurs when there is intravenous invasion by a benign or malignant tumor. We present the case of an asymptomatic patient with an incidentally discovered leiomyosarcoma tumor emboli, which was initially misdiagnosed as “thrombus in transit.” CASE REPORT: The patient was a 58-year-old woman who was incidentally found on echocardiogram to have a large tubular mass within the inferior vena cava and right atrium. Although initially characterized as “thrombus in transit”, this mobile right atrial mass was present without clinical, echocardiographic, or radiographic evidence of pulmonary embolism or increased pulmonary arterial impedance. Given that a thrombus in transit is nearly always associated with submassive or massive pulmonary emboli and their attendant right heart sequelae, these pertinent negative findings led us to seek an alternative diagnosis. After a trial of conservative management with anticoagulation and attempted removal of the mass with the AngioVac system, the patient ultimately underwent median sternotomy and surgical embolectomy on cardiopulmonary bypass to remove the mass, which was later identified on pathology as a leiomyosarcoma. CONCLUSIONS: With rare exceptions, “thrombus in transit” is accompanied by large pulmonary emboli and the presence of increased pulmonary artery pressure and right heart strain. The absence of clinical, echocardiographic, or radio-graphic evidence of these hemodynamic sequelae should raise suspicion for an alternative diagnosis. Tumor embolism should be considered in the differential diagnosis of any patient with a history of malignancy who presents with evidence of intracardiac mass or embolism. International Scientific Literature, Inc. 2020-04-29 /pmc/articles/PMC7209904/ /pubmed/32345956 http://dx.doi.org/10.12659/AJCR.921124 Text en © Am J Case Rep, 2020 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) ) |
spellingShingle | Articles Rosenfeld, Benjamin L. Bashir, Riyaz Brisco-Bacik, Meredith A. Panidis, Ioannis P. Vaidya, Anjali Minakata, Kenji Forfia, Paul R. Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit |
title | Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit |
title_full | Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit |
title_fullStr | Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit |
title_full_unstemmed | Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit |
title_short | Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit |
title_sort | leiomyosarcoma tumor embolism masquerading as thrombus in transit |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7209904/ https://www.ncbi.nlm.nih.gov/pubmed/32345956 http://dx.doi.org/10.12659/AJCR.921124 |
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