Fatal pulmonary tumor embolization following peritoneovenous shunting for malignant ascites

A 44-year-old white male with pseudomyxoma peritonei and intractable malignant ascites is described. This patient underwent three peritoneovenous shunt procedures utilizing first the LeVeen shunt and finally the Denver shunt in a surgical attempt at palliative decompression of his malignant ascites. The peritoneovenous shunts resulted in massive tumor embolization to the pulmonary vasculature, clinically asymptomatic disseminated intravascular coagulation, and partial thrombosis of the superior vena cava. The pulmonary tumor embolization was manifest clinically as moderate pulmonary hypertension with increased pulmonary vascular resistance and persistent hypoxia.