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Pulmonary embolism and megaloblastic anemia: is there a link? A case report an literature review.

ABSTRACT: Many factors have been associated with venous thromboembolism. Among them, vitamin B12 deficiency can produce elevated homocysteine levels, which is a risk factor for venous embolism, since the latter interferes with the activation of Va coagulation factor by activation of C protein. We present a case of a patient with metabolic syndrome with apparently unprovoked pulmonary embolism. After careful evaluation, megaloblastic anemia was detected. Even though the patient had biochemistry findings of hemolysis and blood smear did not showed fragmented erythrocytes, which is consistent with pseudo-microangiopathic hemolytic anemia.

SUBMITTER: Raymundo-Martinez GI

PROVIDER: S-EPMC6141725 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Pulmonary embolism and megaloblastic anemia: is there a link? A case report an literature review.

Raymundo-Martínez Grecia Iveth GI Gopar-Nieto Rodrigo R Carazo-Vargas Gonzalo G Araiza-Garaygordobil Diego D Scuri Sergio Raul SR Rodríguez-Chavez Laura Leticia LL Espinola-Zavaleta Nilda N

Radiology case reports 20180914 6

Many factors have been associated with venous thromboembolism. Among them, vitamin B12 deficiency can produce elevated homocysteine levels, which is a risk factor for venous embolism, since the latter interferes with the activation of Va coagulation factor by activation of C protein. We present a case of a patient with metabolic syndrome with apparently unprovoked pulmonary embolism. After careful evaluation, megaloblastic anemia was detected. Even though the patient had biochemistry findings of ...[more]

PMID: 30233762

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Project description:Tumor embolisms (TE) are an underappreciated source of pulmonary embolisms in sarcoma. Most evidence in the literature is limited to case reports and none have described the presence of TE secondary to myxofibrosarcoma. We report the first case of myxofibrosarcoma TE and perform a review of the literature for TE secondary to bone and soft tissue sarcomas (STS).A 36-year-old female presented with debilitating pain of the right upper extremity secondary to a recurrent soft tissue sarcoma. She had distant metastasis to the lung. An MRI revealed a 25-cm shoulder mass involving the proximal arm muscles with encasement of the axillary artery, vein, and brachial plexus. A palliative forequarter amputation was performed and tumor thrombus was evident within the axillary artery and vein. Postoperatively, she developed an acute onset of dyspnea and hypoxia. A computed tomography scan revealed a pulmonary saddle embolism. A bilateral lower extremity venous duplex was negative. She became hemodynamically unstable despite resuscitation and was placed on vasopressor support. A transthoracic echocardiogram revealed elevated pulmonary artery pressure, tricuspid regurgitation, right heart dilation, and reduced right heart systolic function consistent with acute cor pulmonale. The patient did not want to pursue a median sternotomy with pulmonary artery embolectomy and expired from cardiopulmonary arrest within 24 h of the operation. The final pathology revealed a 25?×?16?×?13 cm high-grade myxofibrosarcoma with invasion into the bone, skin, and neurovascular bundle as well as evidence of tumor thrombus.TE is a rare but deadly cause of pulmonary embolism in sarcoma. A high index of suspicion is necessary in individuals who present with respiratory-related symptoms, especially dyspnea. Diagnostic confirmation with a computed tomography scan of the chest and echocardiogram should be rapid. Unlike venous thromboembolism, pulmonary embolectomy remains the preferred therapeutic approach.

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Pulmonary embolism and megaloblastic anemia: is there a link? A case report an literature review.

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Pulmonary embolism and megaloblastic anemia: is there a link? A case report an literature review.

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