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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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2009-09-01 | GSE13535 | GEO

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Development of massive pulmonary embolism during echocardiographic imaging: A case report.

Project description:RationalePulmonary embolism (PE) is a common diagnostic consideration for patients who present to the emergency department (ED) with chest pain, dyspnea, or both. In addition, PE has a very high mortality in patients who are hemodynamically unstable. An electrocardiography, bedside transthoracic echocardiogram, and computed tomography pulmonary angiogram are usually performed to confirm the diagnosis.Patient concernsA 53-year-old man was admitted to the cardiology clinic with complaints of dyspnea, chest pain, and general weakness after walking. He had a history of hypertension and smoking.DiagnosisDuring synchronous recording of echocardiographic images, a large mobile thrombus detached from the right atrium, and first embolized to the right ventricle and then to the main pulmonary artery from the right heart chambers. Soon after, shortness of breath developed which clinically worsened the patient. Transthoracic echocardiogram which demonstrated the thrombus in the pulmonary artery or right heart chambers was suspected of causing acute massive PE.InterventionsThe patient was transferred to Critical Care Unit for monitoring; 100?mg of alteplase was initiated immediately and alleviated the hemodynamic instability within 2?hours of intravenous administration.OutcomesTo the best of our knowledge, this is the first synchronous echocardiographic recording showing the embolization of a thrombus from the right atrium, first to the right ventricle and then to the main pulmonary artery.LessonsTransthoracic echocardiography provides a safe, rapid, and noninvasive diagnostic tool for evaluation of suspected massive PE. Thrombolytic therapy is useful for treating acute massive PE that leads to hemodynamic instability.

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