Acute cor pulmonale due to tumor cell microemboli

Severe pulmonary hypertension due to tumor cell microemboli or lymphangitic carcinomatosis is a rare complication of malignant disease. In most of the reported cases, a clinical picture of subacute cor pulmonale developed. A 57-year-old man with deep vein thrombosis in his left calf developed acute progressive dyspnea with hypoxemia, cyanosis and the clinical picture of acute cor pulmonale, while he was on full heparinization. Respiratory failure with the need for mechanical ventilatory support developed within 2 days. Chest radiography revealed the development of acute cardiac enlargement, dilated pulmonary artery and diffuse opacities in the fields of both lungs. Open lung biopsy disclosed massive tumor cell microemboli and lymphangitic carcinomatosis. No parenchymal metastases were found. This case is extremely rare because of the rapid development of the patient's respiratory signs and symptoms of acute cor pulmonale due to pulmonary tumor cell microemboli and lymphangitic carcinomatosis. It is also most atypical because of the rare pulmonary radiographic presentation.