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[A "typical" case of pulmonary embolism]
S Reichlin1, H Saner, P Dalquen
1Medizinische Universitätsklinik A, Departement Innere Medizin, Kantonsspital Basel.
Schweizerische Medizinische Wochenschrift
|October 16, 1999
Summary
A rare right ventricular sarcoma caused fatal pulmonary thromboembolism in an elderly woman. This aggressive tumor, often diagnosed post-mortem, highlights the need for considering malignancy in complex pulmonary embolism cases.
Area of Science:
- Cardiology
- Oncology
- Pathology
Background:
- Pulmonary thromboembolism (PTE) is a significant cause of morbidity and mortality.
- Malignancy can present as a cause of PTE, but primary cardiac or pulmonary artery tumors are exceptionally rare.
Observation:
- An 85-year-old woman presented with symptoms suggestive of PTE, including dyspnea and leg swelling.
- Clinical findings included a heart murmur, reduced oxygen saturation, ECG abnormalities, and imaging evidence of cardiomegaly and ventilation-perfusion mismatch.
- Echocardiography revealed pulmonary hypertension and tricuspid regurgitation.
Findings:
- Autopsy revealed a polymorph cellular sarcoma in the right ventricular outflow tract, measuring 6 x 3 x 3 cm.
- The lungs showed a single pulmonary metastasis and multiple thromboemboli of varying ages.
- The sarcoma was the likely cause of the PTE and subsequent multi-organ failure.
Implications:
- This case underscores the importance of considering rare malignancies, such as pulmonary artery sarcomas, in the differential diagnosis of PTE, especially in elderly patients with unexplained symptoms.
- The poor prognosis associated with these tumors emphasizes the need for early detection and diagnosis, although this is often challenging.
- Further research into the early diagnostic markers and treatment strategies for pulmonary artery sarcomas is warranted.