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Lung cancer mimicking massive pulmonary embolism.

ABSTRACT: Pulmonary embolism (PE) is a common finding in patients with underlying malignancy and is the commonest cause of acute cor pulmonale. A 65-year-old woman with a background of non-small-cell lung cancer presented to the emergency department with nausea and vomiting after starting erlotinib; she was pyrexial and had raised C-reactive protein. Despite aggressive fluid resuscitation and antibiotics the patient remained tachycardic, hypotensive, profoundly hypoxic and had a persistent raised jugular venous pulse. Massive PE was therefore suspected. A bedside echocardiogram demonstrated a dilated right ventricle and evidence of pulmonary hypertension. A CT pulmonary angiogram excluded a PE but revealed progression of the right hilar tumour causing complete obstruction of the right upper and middle lobe pulmonary arteries. This case highlights an important differential diagnosis when assessing patients with an underlying intrathoracic tumour with findings suggestive of PE and the importance of obtaining further imaging before considering thrombolysis.

SUBMITTER: Kaier TE

PROVIDER: S-EPMC4543115 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Lung cancer mimicking massive pulmonary embolism.

Kaier Thomas Edward TE Madani Yasser Y

BMJ case reports 20120625

Pulmonary embolism (PE) is a common finding in patients with underlying malignancy and is the commonest cause of acute cor pulmonale. A 65-year-old woman with a background of non-small-cell lung cancer presented to the emergency department with nausea and vomiting after starting erlotinib; she was pyrexial and had raised C-reactive protein. Despite aggressive fluid resuscitation and antibiotics the patient remained tachycardic, hypotensive, profoundly hypoxic and had a persistent raised jugular ...[more]

PMID: 22736782

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Cardiopulmonary Exercise Testing in Patients Following Massive and Submassive Pulmonary Embolism.

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Life-threatening massive pulmonary embolism rescued by venoarterial-extracorporeal membrane oxygenation.

Project description:BackgroundDespite quick implementation of reperfusion therapies, a few patients with high-risk, acute, massive, pulmonary embolism (PE) remain highly hemodynamically unstable. Others have absolute contraindication to receive reperfusion therapies. Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) might lower their right ventricular overload, improve hemodynamic status, and restore tissue oxygenation.MethodsECMO-related complications and 90-day mortality were analyzed for 17 highly unstable, ECMO-treated, massive PE patients admitted to a tertiary-care center (2006-2015). Hospital- discharge survivors were assessed for long-term health-related quality of life. A systematic review of this topic was also conducted.ResultsSeventeen high-risk PE patients [median age 51 (range 18-70) years, Simplified Acute Physiology Score II (SAPS II) 78 (45-95)] were placed on VA-ECMO for 4 (1-12) days. Among 15 (82%) patients with pre-ECMO cardiac arrest, seven (41%) were cannulated during cardiopulmonary resuscitation, and eight (47%) underwent pre-ECMO thrombolysis. Pre-ECMO median blood pressure, pH, and blood lactate were, respectively: 42 (0-106) mmHg, 6.99 (6.54-7.37) and 13 (4-19) mmol/L. Ninety-day survival was 47%. Fifteen (88%) patients suffered in-ICU severe hemorrhages with no impact on survival. Like other ECMO-treated patients, ours reported limitations of all physical domains but preserved mental health 19 (4-69) months post-ICU discharge.ConclusionsVA-ECMO could be a lifesaving rescue therapy for patients with high-risk, acute, massive PE when thrombolytic therapy fails or the patient is too sick to benefit from surgical thrombectomy. Because heparin-induced clot dissolution and spontaneous fibrinolysis allows ECMO weaning within several days, future studies should investigate whether VA-ECMO should be the sole therapy or completed by additional mechanical clot-removal therapies in this setting.

| S-EPMC5369216 | biostudies-literature

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