1
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Lichtblau M, Mayer L, Gopalan D, Dorfmüller P, Ulrich S. Clinical-radiological-pathological correlation in pulmonary hypertension with unclear and/or multifactorial mechanisms. Eur Respir Rev 2023; 32:230119. [PMID: 38123234 PMCID: PMC10731469 DOI: 10.1183/16000617.0119-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/16/2023] [Indexed: 12/23/2023] Open
Abstract
Ever since the second world symposium on pulmonary hypertension (PH) held in Evian, France, in 1998, PH has been classified into five major clinical groups. Group 5 PH includes a variety of distinct conditions with unclear and/or multifactorial underlying pathologies. Management of these patients is challenging as the number of patients within these groups is often small, not all individuals with certain underlying conditions are affected by PH and patients exhibit distinct symptoms due to different underlying diseases. Studies and clinical trials in these groups are largely lacking and mostly restricted to case series and registry reports. Nonetheless, the worldwide burden of group 5 PH is estimated to be significant in terms of the prevalence of some associated diseases. Group 5 PH encompasses six subgroups, including haematological disorders (inherited and acquired chronic haemolytic anaemia and chronic myeloproliferative disorders), systemic disorders (sarcoidosis, pulmonary Langerhans's cell histiocytosis and neurofibromatosis type 1), metabolic disorders (glycogen storage diseases and Gaucher disease), chronic renal failure with or without haemodialysis, pulmonary tumour thrombotic microangiopathy and fibrosing mediastinitis.
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Affiliation(s)
- Mona Lichtblau
- University and University Hospital of Zurich, Zurich, Switzerland
| | - Laura Mayer
- University and University Hospital of Zurich, Zurich, Switzerland
| | - Deepa Gopalan
- Imperial College London, London, UK
- Cambridge University Hospital, Cambridge, UK
| | - Peter Dorfmüller
- Universitätsklinikum Gießen und Marburg GmbH, Pathology Department, Giessen, Germany
| | - Silvia Ulrich
- University and University Hospital of Zurich, Zurich, Switzerland
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2
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Gil-García CA, Cueto-Robledo G, Gonzalez-Hermosillo LM, Alfaro-Cruz A, Roldan-Valadez E. Nonthrombotic Pulmonary Embolism Associated With Non-Hodgkin Lymphoma. Curr Probl Cardiol 2023; 48:102001. [PMID: 37506958 DOI: 10.1016/j.cpcardiol.2023.102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Nonthrombotic pulmonary embolism (NTPE) challenges the medical community with its diverse etiologies and potential life-threatening implications. The classification section delves into the multifaceted nature of NTPE, which includes various embolic agents that traverse the vascular system. From air and fat emboli to tumor and amniotic fluid emboli, this exploration of diverse etiologies sheds light on the complexity of NTPE. Diagnostic methods play a crucial role in the effective management of NTPE. This article describes a range of traditional and cutting-edge diagnostic techniques, from computed tomography angiography to novel biomarkers, enabling the accurate and timely identification of NTPE. NTPE treatment options are diverse and patient-specific, requiring customized approaches to address varying embolic sources. Anticoagulation, embolus removal, and emerging interventions under study are discussed, providing clinicians with a comprehensive understanding of management strategies. This article uncovers the rare but captivating association between NTPE and non-Hodgkin lymphoma. Although rare, documented cases have sparked curiosity among researchers and medical practitioners. We explore potential pathophysiological connections, discussing challenges and considerations when encountering this unique scenario. In conclusion, this captivating review encapsulates the multifaceted realm of NTPE, covering its classification, diagnostics, and treatment modalities. Moreover, it presents a fascinating connection with non-Hodgkin lymphoma. This article offers a comprehensive and concise review of NTPE, guiding readers through its intricate classification, diagnostic approaches, and therapeutic interventions.
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Affiliation(s)
- Cesar-Alejandro Gil-García
- Faculty of Medicine, Autonomous University of Sinaloa, Los Mochis, Sinaloa, México; Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Guillermo Cueto-Robledo
- Cardiorespiratory Emergencies, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Pulmonary Circulation Clinic, General Hospital of Mexico "Dr. Eduardo Liceaga", Mexico City, Mexico; Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico.
| | | | - Ana Alfaro-Cruz
- Department of Surgical Pathology, General Hospital of Mexico, "Dr. Eduardo Liceaga," Mexico City, Mexico
| | - Ernesto Roldan-Valadez
- Directorate of Research, General Hospital of Mexico "Dr. Eduardo Liceaga," Mexico City, Mexico; Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
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3
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Aeberhard J, Lichtblau M, Arenja N. An unexpected cause of pulmonary hypertension in a young woman: a case report. Eur Heart J Case Rep 2023; 7:ytad474. [PMID: 37850218 PMCID: PMC10577277 DOI: 10.1093/ehjcr/ytad474] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 09/12/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023]
Abstract
Background Pulmonary hypertension (PH) is defined as a progressive disease that leads to right heart failure and death if untreated. This case report presents a young woman with reversible precapillary PH in the setting of a gastric cancer. Case summary A 37-year-old woman presented with exertional dyspnoea and syncope. The transthoracic echocardiographic findings were consistent with a cor pulmonale. Right heart catheterization (RHC) proved a precapillary PH. Specific PH therapy with macitentan and tadalafil was initiated. Shortly thereafter, a gastric carcinoma was diagnosed, and oncologic treatment with neoadjuvant chemotherapy and subsequent gastrectomy was promptly initiated. Retrospectively, we considered a pulmonary tumour thrombotic microangiopathy the most probable cause of PH. Follow-up after successful oncologic treatment and cumulative 10 months of specific PH medication showed an excellent clinical response with complete remission of PH confirmed by RHC at rest. Discussion Tumour-related PH is very rare and might be largely underdiagnosed as the clinical course often results in a rapid deterioration and fatal outcome before diagnostics are completed. Post mortem studies have documented tumoural emboli in pulmonary microcirculation in ∼26% of patients with a solid tumour, markedly associated with adenocarcinoma. Prompt initiation of cancer treatment on tumoural PH is essential. To our knowledge, this report documents the first full recovery of tumoural PH at rest after successful cancer treatment and temporary specific PH medication. We therefore conclude that a multidisciplinary approach with an initially combined oncologic and PH therapy may be most beneficial with the potential of complete remission of PH.
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Affiliation(s)
- Judith Aeberhard
- Department of Cardiology, Kantonsspital Olten, 4600 Olten, Switzerland
| | - Mona Lichtblau
- Clinic of Pulmonology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Nisha Arenja
- Department of Cardiology, Kantonsspital Olten, 4600 Olten, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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4
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Wang K, Verma A, Fish KE, Hu JR, Miller PE, Morrow JS, Singh I, Young LH. A Case of Fulminant Right Heart Failure Owing to Tumoral Pulmonary Hypertension. JACC Case Rep 2023; 10:101715. [PMID: 36974052 PMCID: PMC10039392 DOI: 10.1016/j.jaccas.2022.101715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
Tumoral pulmonary hypertension is a rare cause of pulmonary hypertension. We report a patient who was thought to have idiopathic pulmonary arterial hypertension, but later developed fulminant right heart failure ultimately leading to death. Autopsy revealed substantial pulmonary tumor embolism burden originating from liver adenocarcinoma. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Kedong Wang
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anuj Verma
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kaitlin E. Fish
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jiun-Ruey Hu
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - P. Elliott Miller
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jon S. Morrow
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Inderjit Singh
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lawrence H. Young
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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5
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Cortopassi IO, Gosangi B, Asch D, Bader AS, Gange CP, Rubinowitz AN. Diseases of the pulmonary arteries: imaging appearances and pearls. Clin Imaging 2022; 91:111-125. [DOI: 10.1016/j.clinimag.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
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6
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Value of 18F-FDG PET/CT Combined with Lung HRCT in Diagnosis of Solitary Pulmonary Intravascular Metastasis. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8968855. [PMID: 35280706 PMCID: PMC8885262 DOI: 10.1155/2022/8968855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/02/2022] [Indexed: 11/24/2022]
Abstract
Background Solitary pulmonary intravascular metastasis is a rare complication of malignant tumors, and accurate diagnosis can improve clinical decision-making, but diagnosing it effectively using conventional techniques is difficult. Purpose To explore the value of 18F-FDG PET/CT combined with lung high-resolution computed tomography (HRCT) in the diagnosis of solitary pulmonary intravascular metastasis. Methods 18F-FDG PET/CT, lung HRCT, and follow-up data of 18,143 cancer patients were retrospectively analyzed to select patients with pulmonary vessel involvement besides the primary tumor only. The histopathological or imaging follow-up results were used as the diagnostic criteria for pulmonary intravascular metastasis. Results A total of 13 patients with 17 pulmonary intravascular metastases were found, of which 9 patients had a single lesion and 4 had double. The SUVmax was 1.1–5.4 (average, 2.4 ± 1.4), and the length of hypermetabolic metastasis was 5.1–24.1 mm (average, 10.7 ± 6.5 mm). All the intravascular metastases were located in the terminal pulmonary vessels. Strip or branched pulmonary vessels enlargement with increased metabolism was the main imaging manifestation (15/17, 88.2%), while the other 2 cases only showed strip metabolic enhancement without abnormalities in pulmonary vessels (2/17, 11.8%). Four pulmonary intravascular metastases were confirmed by pathology, and the other 13 cases were diagnosed by imaging follow-up. Conclusion 18F-FDG PET/CT combined with lung HRCT is an effective technique for the diagnosis of solitary pulmonary intravascular metastasis. High-strip or branched FDG uptake in the distal pulmonary vessel accompanied by corresponding morphological changes in patients with malignant tumors can be used as a specific diagnostic indicator.
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7
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Katano T, Tsuzuki T, Numanami H, Sassa N, Kato T, Kubo A, Ito S. A case of renal cell carcinoma with microscopic pulmonary tumor embolism proven by surgical lung biopsy. Respir Med Case Rep 2022; 39:101716. [PMID: 35958348 PMCID: PMC9358455 DOI: 10.1016/j.rmcr.2022.101716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/05/2022] [Accepted: 07/21/2022] [Indexed: 11/25/2022] Open
Abstract
Pulmonary tumor embolism (PTE) is difficult to diagnose before death. We report the case of a 75-year-old man with microscopic PTE of renal cell carcinoma who was diagnosed by surgical lung biopsy. He visited our hospital because of dyspnea on exertion. Chest computed tomography (CT) showed multiple micronodules and ground glass opacities. Steroid therapy was started as therapeutic diagnosis for IgG4-related pulmonary disease. However, he was admitted our hospital due to progressive respiratory failure. Pathological findings of a lung biopsy obtained by video-assisted thoracic surgery showed PTE of renal cell carcinoma without embolization of large pulmonary arteries. He received palliative medicine and died four months after the surgical lung biopsy. In cases of multiple micronodules in chest CT findings and worsened respiratory symptoms, PTE should be considered in the differential diagnosis.
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8
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Rajdev K, Madan U, McMillan S, Wilson K, Fisher K, Hein A, Patil A, Bista S, Hershberger D, Boer B. Pulmonary Tumor Embolism and Pulmonary Tumor Thrombotic Microangiopathy Causing Rapidly Progressive Respiratory Failure: A Case Series. J Investig Med High Impact Case Rep 2022; 10:23247096221086453. [PMID: 35313765 PMCID: PMC8943465 DOI: 10.1177/23247096221086453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/14/2022] [Accepted: 02/20/2022] [Indexed: 11/04/2022] Open
Abstract
Pulmonary tumor embolism (PTE) and pulmonary tumor thrombotic microangiopathy (PTTM) are rare etiologies for rapidly progressive dyspnea in the setting of undiagnosed metastatic cancer. They occur most frequently in association with adenocarcinomas, with PTE being most frequently associated with hepatocellular carcinoma and PTTM being most commonly reported with gastric adenocarcinoma. Pulmonary tumor embolism and PTTM appear to be a disease spectrum where PTTM represents an advanced form of PTE. Pulmonary tumor embolism and PTTM are mostly identified postmortem during autopsy as the antemortem diagnosis remains a clinical challenge due to the rapidly progressive nature of these rare diseases. We report 2 cases of rapidly progressive respiratory failure leading to death, due to tumoral pulmonary hypertension resulting from PTE and PTTM, diagnosed postmortem. Both of the patients were middle-aged females, nonsmokers, and had a gastrointestinal source of their primary malignancy.
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Affiliation(s)
| | - Ujjwal Madan
- University College of Medical
Sciences, Delhi, India
| | | | - Kyle Wilson
- University of Nebraska Medical
Center, Omaha, USA
| | - Kurt Fisher
- University of Nebraska Medical
Center, Omaha, USA
| | - Ashley Hein
- University of Nebraska Medical
Center, Omaha, USA
| | - Amol Patil
- University of Nebraska Medical
Center, Omaha, USA
| | - Sabin Bista
- University of Nebraska Medical
Center, Omaha, USA
| | | | - Brian Boer
- University of Nebraska Medical
Center, Omaha, USA
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9
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He X, Anthony DC, Catoni Z, Cao W. Pulmonary tumor embolism: A retrospective study over a 30-year period. PLoS One 2021; 16:e0255917. [PMID: 34379693 PMCID: PMC8357121 DOI: 10.1371/journal.pone.0255917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022] Open
Abstract
Background Pulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis. Methods We performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival. Results We found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3–17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240). Conclusions The incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.
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Affiliation(s)
- Xin He
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Pathology, University of Massachusetts School of Medicine, Worcester, MA, United States of America
| | - Douglas C. Anthony
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Neurology, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Zulmira Catoni
- Human Information Management, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Weibiao Cao
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- Department of Medicine, Rhode Island Hospital and The Alpert Medical School of Brown University, Providence, RI, United States of America
- * E-mail:
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10
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The diagnostic challenge in pulmonary tumour embolism in cancer: a case report and literature review. Contemp Oncol (Pozn) 2021; 24:258-262. [PMID: 33531874 PMCID: PMC7836275 DOI: 10.5114/wo.2020.102631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary tumour embolism is a rare condition without specific symptoms or pathognomonic features. Pulmonary tumour embolism can occur as the first manifestation of cancer, but because of diagnostic difficulties, it is often wrongly recognised as a more common cardiopulmonary disease. We present a case of a 46-year-old Caucasian male with no prior malignancy diagnosis, admitted because of progressing dyspnoea and cough. Based on radiological and clinical presentations, sarcoidosis, silicosis and lymphangitic carcinomatosis were considered in the differential diagnosis. Histopathological analysis of lung biopsy revealed that multiple emboli of atypical epithelial cells found in the pulmonary vessels were of gastrointestinal origin. Further pathological examination of the gastric biopsy led to the final diagnosis of the signet-ring cells gastric adenocarcinoma. The patient was referred for chemotherapy. After a short-term partial remission, he died within two months after the final diagnosis. The presented case illustrates challenges posed by the diagnostic process of pulmonary tumour embolism.
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11
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Uncommon thoracic manifestations from extrapulmonary tumors: Computed tomography evaluation - Pictorial review. Respir Med 2020; 168:105986. [PMID: 32469707 DOI: 10.1016/j.rmed.2020.105986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 11/23/2022]
Abstract
Although metastasis can occur at a variety of sites, pulmonary involvement is common in patients with cancer. Depending on the source and type of tumor, pulmonary metastases present with a wide range of radiologic appearances. Hematogenous dissemination through the pulmonary arteries to the pulmonary capillary network is the most common form of spread in pulmonary metastases. However, they may also reach the lung via lymphatic dissemination, secondary airway involvement, vessel tumor embolism, and direct chest invasion. In the evaluation of patients with known extrathoracic tumors, CT is the state-of-the-art imaging modality for detecting and characterize pulmonary metastases as well as to predict resectability. Although CT limitations are well known, knowledge of growth rates of various tumors and understanding the pattern of spread may be helpful clues in suggesting and even establish the specific diagnosis. The purpose of this pictorial review is to discuss the imaging appearances of different patterns of intrathoracic tumoral dissemination.
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12
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Morin-Thibault LV, Wiseman D, Joubert P, Paulin R, Bonnet S, Provencher S. Pulmonary tumor thrombotic microangiopathy: A systematic review of the literature. CANADIAN JOURNAL OF RESPIRATORY, CRITICAL CARE, AND SLEEP MEDICINE 2020. [DOI: 10.1080/24745332.2020.1724061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- L. V. Morin-Thibault
- Pulmonary Hypertension Research Group, Laval University, Québec City, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
| | - D. Wiseman
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - P. Joubert
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
| | - R. Paulin
- Pulmonary Hypertension Research Group, Laval University, Québec City, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
- Department of Medicine, Laval University, Québec City, Québec, Canada
| | - S. Bonnet
- Pulmonary Hypertension Research Group, Laval University, Québec City, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
- Department of Medicine, Laval University, Québec City, Québec, Canada
| | - S. Provencher
- Pulmonary Hypertension Research Group, Laval University, Québec City, Québec, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Québec, Canada
- Department of Medicine, Laval University, Québec City, Québec, Canada
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13
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Narechania S, Renapurkar R, Heresi GA. Mimickers of chronic thromboembolic pulmonary hypertension on imaging tests: a review. Pulm Circ 2020; 10:2045894019882620. [PMID: 32257112 PMCID: PMC7103595 DOI: 10.1177/2045894019882620] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/21/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is caused by mechanical obstruction of large pulmonary arteries secondary to one or more episodes of pulmonary embolism. Ventilation perfusion scan is the recommended initial screening test for this condition and typically shows multiple large mismatched perfusion defects. However, not all patients with an abnormal ventilation perfusion scan have CTEPH since there are other conditions that be associated with a positive ventilation perfusion scan. These conditions include in situ thrombosis, pulmonary artery sarcoma, fibrosing mediastinitis, pulmonary vasculitis and sarcoidosis, among others. Although these conditions cannot be distinguished from CTEPH using a ventilation perfusion scan, they have certain characteristic radiological features that can be demonstrated on other imaging techniques such as computed tomography scan and can help in differentiation of these conditions. In this review, we have summarized some key clinical and radiological features that can help differentiate CTEPH from the CTEPH mimics.
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Affiliation(s)
| | - Rahul Renapurkar
- Department of Diagnostic Radiology,
Cleveland
Clinic, Cleveland, OH, USA
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14
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Frazier AA, Hossain R. A Spectrum of Metastatic Disease in the Chest: Insights for the Radiologist. Semin Roentgenol 2019; 55:51-59. [PMID: 31964481 DOI: 10.1053/j.ro.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Aletta Ann Frazier
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD; American Institute for Radiologic Pathology, American College of Radiology, Silver Spring, MD.
| | - Rydhwana Hossain
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
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15
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Gioia MR, Maccari U, Marchetti L, Maglioni E, Ciarleglio G, Granese V, Salerno L, Spagnoli L, Zanellato I, Ambrosio MR, Bianco A, Scala R. Occult malignancy underlying a case of "hyperacute" onset of severe pulmonary hypertension. ERJ Open Res 2019; 5:00157-2019. [PMID: 31637250 PMCID: PMC6791963 DOI: 10.1183/23120541.00157-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/03/2019] [Indexed: 11/07/2022] Open
Abstract
“Tumoral pulmonary hypertension (PH)” includes several subtypes of conditions leading to abnormal levels of pulmonary artery or venous pressure occurring in patients with a current or previous malignancy. Pulmonary tumour “microvascular disease” includes both pulmonary tumour microembolism (PTE) and pulmonary tumour thrombotic microangiopathy (PTTM) that are likely to be part of the same spectrum disease [1]. PTE was described in early studies, and was defined as the occlusion of the pulmonary microvasculature by tumour cells and associated thrombi. Tumour thrombi are frequently formed by malignant cells, platelets and fibrin, and are highly resistant to recanalisation and lead to an irreversible obstruction. In many cases, they are associated with vascular tissue reaction characterised by extensive fibrocellular intimal hyperplasia of small pulmonary arteries initiated by tumour microemboli known as PTTM [1, 2]. Most reported cases of PTE occur in association with adenocarcinomas, including liver [3, 4], kidney, breast [5, 6], stomach [4, 7], bladder and choriocarcinoma [8]. In a handful of cases of PTE, estimated at 5% [9], the primary cancer is unknown. Ante mortem diagnosis of PTE is often challenging and the majorities of cases are identified as results of post mortem studies. This is especially true for a subset of patients with occult malignancy and acute onset of severe PH. Investigations in a patient with new-onset pulmonary hypertension should include screening for undiagnosed malignancyhttp://bit.ly/2mrLmGM
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Affiliation(s)
| | - Uberto Maccari
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Luca Marchetti
- Anaesthesiology and Cardio-thoracic Intensive Care Unit "Le Scotte" Siena, Siena, Italy
| | - Enivarco Maglioni
- Anaesthesiology and Cardio-thoracic Intensive Care Unit "Le Scotte" Siena, Siena, Italy
| | | | - Valentina Granese
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Laura Salerno
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Luigi Spagnoli
- Dept of Medical Biotechnology, University of Siena, Siena, Italy
| | - Ilenia Zanellato
- Dept of Medical Biotechnology, University of Siena, Siena, Italy
| | | | - Andrea Bianco
- Dept of Translational Medical Sciences, Monaldi Hospital, Naples, Italy
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
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16
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Kirsch D, Scordi-Bello I. Fatal Microscopic Pulmonary Tumor Thromboemboli: Unusual Presentation of Occult Cervical Carcinoma. Two Case Reports and Review of the Literature. Acad Forensic Pathol 2019; 9:81-92. [PMID: 34394793 DOI: 10.1177/1925362119851131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/05/2019] [Indexed: 11/15/2022]
Abstract
Cor pulmonale (right heart failure) due to microscopic pulmonary tumor emboli (MPTE) can arise from a variety of malignancies including breast, lung, and liver and carries significant morbidity and mortality. Tumor cell aggregates spread hematogenously to the lungs and occlude small pulmonary vessels leading to pulmonary hypertension through either a mechanical process or inducing vascular remodeling as a downstream result of interactions between the embolus and the vessel wall. Its presentation includes unexplained dyspnea, hypoxemia, tachycardia, pulmonary hypertension, right heart failure, and in some cases sudden death. The symptoms may suggest the more common entity of pulmonary thromboembolism, particularly in the setting of previously known metastatic cancer; however, computed tomography scans may appear normal and ventilation-perfusion scans which are the preferable diagnostic modality are not always ordered. In most cases of MPTE, the presentation reflects metastasis of an already known and advanced tumor, but, in rare cases, it may be the primary manifestation of an occult malignancy. We present here 2 unique cases of MPTE in women with occult cervical cancer. In both cases, the malignancy was discovered and diagnosed at autopsy. Microscopic pulmonary tumor emboli can be easily overlooked, and therefore, forensic pathologists and other death investigators should be aware of it and trained to at least consider the possibility in appropriate situations. Thorough microscopic examination of apparently normal tissues may be necessary, particularly in cases of unexplained right heart failure and sudden death, even if the decedent has few or no identifiable risk factors for cancer.
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Rudkovskaia AA, Bandyopadhyay D. Intraluminal Arterial Filling Defects Misdiagnosed as Pulmonary Emboli: What Else Could They Be? Clin Chest Med 2019; 39:505-513. [PMID: 30122175 DOI: 10.1016/j.ccm.2018.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Pulmonary artery filling defects can be observed in various pathologic processes other than pulmonary embolism, for example, nonthrombotic pulmonary embolism with biological and nonbiological materials and intrinsic pulmonary artery lesions. They have also been described in rare conditions, such as fibrosing mediastinitis and congenital absence or stenosis of pulmonary artery, and some pulmonary parenchymal and airway malignancies. Misdiagnosis is common owing to the relative rarity of these conditions. Correct diagnosis is based on the appropriate clinical suspicion considering the unique clinical features, laboratory findings, and additional radiologic clues inferring a pathology other than pulmonary embolism.
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Affiliation(s)
- Anastasiia A Rudkovskaia
- Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA.
| | - Debabrata Bandyopadhyay
- Pulmonary and Critical Care Medicine, Geisinger, 100 North Academy Avenue, Danville, PA 17822-1334, USA
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18
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Price LC, Seckl MJ, Dorfmüller P, Wort SJ. Tumoral pulmonary hypertension. Eur Respir Rev 2019; 28:28/151/180065. [DOI: 10.1183/16000617.0065-2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/23/2018] [Indexed: 12/15/2022] Open
Abstract
Tumoral pulmonary hypertension (PH) comprises a variety of subtypes in patients with a current or previous malignancy. Tumoral PH principally includes the tumour-related pulmonary microvascular conditions pulmonary tumour microembolism and pulmonary tumour thrombotic microangiopathy. These inter-related conditions are frequently found inpost mortemspecimens but are notoriously difficult to diagnoseante mortem. The outlook for patients remains extremely poor although there is some emerging evidence that pulmonary vasodilators and anti-inflammatory approaches may improve survival. Tumoral PH also includes pulmonary macroembolism and tumours that involve the proximal pulmonary vasculature, such as angiosarcoma; both may mimic pulmonary embolism and chronic thromboembolic PH. Finally, tumoral PH may develop in response to treatments of an underlying malignancy. There is increasing interest in pulmonary arterial hypertension induced by tyrosine kinase inhibitors, such as dasatanib. In addition, radiotherapy and chemotherapeutic agents such as mitomycin-C can cause pulmonary veno-occlusive disease. Tumoral PH should be considered in any patient presenting with unexplained PH, especially if it is poorly responsive to standard approaches or there is a history of malignancy. This article will describe subtypes of tumoral PH, their pathophysiology, investigation and management options in turn.
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Okazaki S, Abe T, Takayanagi N, Yasuda M, Sakai F, Kobayashi K, Kato S. Pulmonary Tumor Embolism Due to Squamous Cell Carcinoma of the Uterine Cervix: A Case Report. ACTA ACUST UNITED AC 2018; 32:337-343. [PMID: 29475918 DOI: 10.21873/invivo.11243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND/AIM We report on a case of pulmonary tumor embolism caused by squamous cell carcinoma of the uterine cervix. PATIENTS AND METHODS A 60-year-old female diagnosed with stage IVB (cT4N1M1) squamous cell carcinoma of the uterine cervix was admitted to our institution with a chief complaint of progressive dyspnea that developed within a few days after admission. RESULTS A chest CT scan showed dilated pulmonary arteries, right ventricular enlargement and mosaic ground-glass opacities in both lungs. An echocardiogram revealed elevated right ventricular pressure and a floppy mass in the right ventricle. Pulmonary tumor embolism was highly suspected. However, she died from respiratory failure on the fourth day after admission. Autopsy revealed diffuse tumor emboli in bilateral pulmonary arteries and arterioles. CONCLUSION Pulmonary tumor embolism should be considered when patients with malignant disease develop unexplained dyspnea, hypoxemia, and pulmonary hypertension.
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Affiliation(s)
- Shohei Okazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Takanori Abe
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Natsuko Takayanagi
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Fumikazu Sakai
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
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20
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Morin-Thibault LV, Wiseman D, Fortin M, Couture C, Provencher S. Pulmonary micro-tumor emboli resulting in paradoxical emboli: a case report. Pulm Circ 2018; 8:2045893218754853. [PMID: 29308711 PMCID: PMC5826013 DOI: 10.1177/2045893218754853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pulmonary tumor embolism (PTE) is a rare manifestation of cancer. It is characterized by the presence of tumor cell emboli in the pulmonary arterioles and capillaries leading to an elevation of pulmonary vascular resistance. The ante-mortem diagnosis is difficult. We report a case of PTE associated with recurrent breast cancer that presented with neurological symptoms due to paradoxical cerebral embolism.
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Affiliation(s)
- Louis-Vincent Morin-Thibault
- 1 Pulmonary Hypertension Research Group ( http://www.hypertensionarteriellepulmonaire.ca ).,2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Daniel Wiseman
- 2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Michelle Fortin
- 2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Christian Couture
- 2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada
| | - Steeve Provencher
- 1 Pulmonary Hypertension Research Group ( http://www.hypertensionarteriellepulmonaire.ca ).,2 55973 Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Quebec City, QC, Canada.,3 Department of Medicine, Université Laval, Québec City, QC, Canada
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21
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Kitayama H, Yokota T, Kondo T, Sugiyama J, Hirayama M, Oyamada Y, Tsuji Y. Unusual Development of Pulmonary Tumor Embolism from Controlled Liver Metastases of Transitional Cell Carcinoma: An Autopsy Case. Intern Med 2016; 55:2453-6. [PMID: 27580549 DOI: 10.2169/internalmedicine.55.6662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Clinicians generally suspect pulmonary tumor embolism (PTE) with uncontrolled carcinomas which often spread to lungs. We, however, experienced an autopsy case of diffuse microscopic PTE despite controlled liver metastases of transitional cell carcinoma (TCC). A 66-year-old man with progressing respiratory symptoms showed almost normal chest findings on computed tomography. Although liver metastases were successfully shrunk by chemotherapy, the patient died from aggressive respiratory failure. An autopsy revealed small pulmonary vessels showing diffuse tumor emboli. TCC can cause PTE even if liver metastases are controlled. We must therefore be aware that PTE can manifest as respiratory symptoms without any computed tomography findings.
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22
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Vial MR, Sarkiss M, Lazarus DR, Eapen G. Endobronchial ultrasound-guided diagnosis of pulmonary artery tumor embolus. Ann Thorac Surg 2015; 99:1816-9. [PMID: 25952219 DOI: 10.1016/j.athoracsur.2014.06.111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 06/18/2014] [Accepted: 06/24/2014] [Indexed: 11/18/2022]
Abstract
A patient diagnosed with pulmonary embolism had persistent symptoms despite adequate therapy. Tissue sampling with endobronchial ultrasound-guided needle aspiration revealed endovascular metastasis from a prior early-stage colorectal cancer. We describe the challenges in the diagnosis and workup of suspected tumor emboli.
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Affiliation(s)
- Macarena R Vial
- Division of Pulmonary Medicine, Clinica Alemana de Santiago, Universidad del Desarrollo, Chile
| | - Mona Sarkiss
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald R Lazarus
- Department of Pulmonary Medicine, Baylor College of Medicine, Houston, Texas
| | - George Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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23
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Podduturi V, Campa-Thompson MM, Zhou XJ, Guileyardo JM. Malignant rhabdoid tumor of the kidney arising in an adult patient. Proc (Bayl Univ Med Cent) 2014; 27:239-41. [PMID: 24982576 DOI: 10.1080/08998280.2014.11929125] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Malignant rhabdoid tumors (MRT) of the kidney are rare in children and even less common in adults, with only six previously reported adult cases. We present the case of a 60-year-old man with an MRT arising in the left kidney with extensive pulmonary micrometastases and thromboembolism resulting in thrombotic pulmonary microangiopathy (pulmonary tumor embolism syndrome). MRT is an extremely aggressive neoplasm with a short survival time.
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Affiliation(s)
- Varsha Podduturi
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Molly M Campa-Thompson
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Xin J Zhou
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center at Dallas (Podduturi, Campa-Thompson, Zhou, Guileyardo); and Renal Path Diagnostics, Pathologists Bio-Medical Laboratories, Lewisville, Texas (Zhou)
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24
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Batalis NI, Harley RA. Pulmonary Embolic Disorders. Acad Forensic Pathol 2013. [DOI: 10.23907/2013.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Deaths due to pulmonary thromboemboli are frequently encountered by the forensic pathologist and account for a significant percentage of sudden, unexpected deaths. Diagnosing these straightforward cases is often not a challenge, but unfortunately some cases in which a thromboembolism is expected can become complicated. Occasionally, a postmortem clot may mimic a thromboembolism and lead to a mistaken diagnosis, and in other situations it may become paramount to attempt to age a thrombus as part of a medicolegal lawsuit. Additionally, many individuals use the less specific term, “pulmonary emboli”, when referring to these cases in which a portion of a thrombus, usually originating in the deep veins of the lower extremities, breaks off and travels to the pulmonary vasculature bed where it occludes vessels and leads to a rapid demise. One must remember, though, that several other materials and tissues including fat, amniotic fluid, air, tumors, solid organs, synthetic materials, and parasites may be displaced and embolize to the lungs and cause significant disease. In the following pages we will provide a thorough review of pulmonary embolic disorders, focusing on those diseases most likely to be encountered by the forensic pathologist. The aim of this review is to aid the pathologist in using proper terminology, diagnosing various types of embolic disorders, and recognizing potential mimics.
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Affiliation(s)
- Nicholas I. Batalis
- Medical University of South Carolina
- Medical University of South Carolina - Department of Pathology and Lab Medicine, Charleston, SC, and The Joint Pathology Center - Pulmonary Pathology, Silver Spring, MD (RH)
| | - Russell A. Harley
- Medical University of South Carolina - Department of Pathology and Lab Medicine, Charleston, SC, and The Joint Pathology Center - Pulmonary Pathology, Silver Spring, MD (RH)
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25
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Saddle pulmonary tumor embolus secondary to renal cell carcinoma. JAAPA 2013; 26:37-9. [PMID: 24153090 DOI: 10.1097/01.jaa.0000436685.90928.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most pulmonary tumor emboli are microscopic and occlude small arteries and arterioles with subsequent insidious clinical presentation. These emboli usually need conservative treatment. Emboli that spread to large proximal pulmonary arteries, although rare, can be life-threatening. This article focuses on the importance of prompt recognition, diagnosis, and appropriate management of pulmonary tumor emboli.
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26
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Cheng S, Mohammed TLH. Metastatic Disease to the Lungs and Pleura: An Overview. Semin Roentgenol 2013; 48:335-43. [DOI: 10.1053/j.ro.2013.03.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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27
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Singh RK, Thangakunam B, Isaac B, Christopher DJ. Cannonball shadow in the lungs and pulmonary embolism in a young man. BMJ Case Rep 2013; 2013:bcr-2012-007541. [PMID: 23853007 DOI: 10.1136/bcr-2012-007541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ranjit Kumar Singh
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
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28
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Heithaus RE, Hitchcock MA, Guileyardo JM. Pulmonary tumor embolism syndrome from occult colonic adenocarcinoma. Proc (Bayl Univ Med Cent) 2013; 26:290-2. [PMID: 23814395 DOI: 10.1080/08998280.2013.11928987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Pulmonary tumor embolism syndrome is a rare phenomenon that can occur in patients who have an occult neoplasm that metastasizes. We describe a case of an elderly woman with an undiagnosed colon cancer who suffered from respiratory distress and compromised pulmonary blood flow from micrometastasis in the pulmonary arteries.
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Affiliation(s)
- Robert Evans Heithaus
- Departments of Radiology (Heithaus) and Pathology (Hitchcock, Guileyardo), Baylor University Medical Center at Dallas
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29
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Buderi S, Theologou T, Gosney J, Shackcloth M. Pulmonary Artery Tumor Embolism in a Patient With Previous Fibroblastic Osteosarcoma. Ann Thorac Surg 2013; 95:2155-7. [DOI: 10.1016/j.athoracsur.2012.10.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 10/08/2012] [Accepted: 10/22/2012] [Indexed: 10/26/2022]
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30
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Bach AG, Restrepo CS, Abbas J, Villanueva A, Lorenzo Dus MJ, Schöpf R, Imanaka H, Lehmkuhl L, Tsang FHF, Saad FFA, Lau E, Alvarez JR, Battal B, Behrmann C, Spielmann RP, Surov A. Imaging of nonthrombotic pulmonary embolism: Biological materials, nonbiological materials, and foreign bodies. Eur J Radiol 2013; 82:e120-41. [DOI: 10.1016/j.ejrad.2012.09.019] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/06/2012] [Accepted: 09/12/2012] [Indexed: 12/21/2022]
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31
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Worster A, Sharma S, Mookadam F, Opie J. Acute presentation of choriocarcinoma: a case study and review of the literature. CAN J EMERG MED 2012; 4:111-4. [PMID: 17612431 DOI: 10.1017/s1481803500006230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report an unusual case of a 27-year-old male with an acute presentation of choriocarcinoma. The patient presented with unstable vital signs, severe anemia and a widened arterial pulse pressure following a several day history of testicular pain. He was subsequently diagnosed as having testicular choriocarcinoma with multiple hepatic metastases and large hemorrhagic para-aortic lymph nodes. The widened pulse pressure persisted during fluid resuscitation and correction of both the anemia and hypotension, and only narrowed after the initiation of chemotherapy. A literature review indicates that metastatic testicular choriocarcinoma is a rare but aggressive malignancy that often presents with acute symptoms and signs that cause patients to seek emergency care. We summarize the reported cases of "acute" testicular choriocarcinoma presentation and briefly discuss its relationship to widened arterial pulse pressure.
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Affiliation(s)
- Andrew Worster
- Department of Emergency Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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32
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Hibino M, Akazawa K, Hikino K, Oe M. Pulmonary tumor embolism secondary to uterine corpus carcinosarcoma mimicking pulmonary thromboembolism. Intern Med 2012; 51:2603-7. [PMID: 22989834 DOI: 10.2169/internalmedicine.51.7220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of pulmonary tumor embolism caused by hematogenous metastasis that mimicked pulmonary thromboembolism in a 62-year-old Japanese woman with a history of uterine corpus carcinosarcoma. The case suggests that tumor embolism must be included in the differential diagnoses of respiratory symptoms in patients with a history of malignancy. It also illustrates the usefulness of such findings as beaded, dilated pulmonary arteries by computed tomography (CT) and high (18)F-fluorodeoxyglucose (FDG) uptake by fusion FDG positron emission tomography/CT imaging for differentiating a pulmonary tumor embolism from pulmonary thromboembolism.
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Affiliation(s)
- Makoto Hibino
- Department of Respiratory Medicine, Chigasaki Tokusyukai Medical Center, Japan.
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33
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Gentle S, Fisher C, Soni N, Hill S, Thomas JM. Pulmonary tumour embolism complicating a case of leiomyosarcoma. Sarcoma 2011; 2:201-3. [PMID: 18521255 PMCID: PMC2395391 DOI: 10.1080/13577149877984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Patient. A case of peripheral leiomyosarcoma presenting with features of pulmonary thromboembolism is described. Discussion. Persistence of the embolus despite triple-armed thrombolytic therapy and the presence of intravascular tumour invasion suggest the rare entity of pulmonary tumour embolism from a leiomyosarcoma.
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Affiliation(s)
- S Gentle
- Chelsea and Westminster Hospital London UK
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34
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The effectiveness of particle radiotherapy for hepatocellular carcinoma associated with inferior vena cava tumor thrombus. J Gastroenterol 2011; 46:913-20. [PMID: 21516295 DOI: 10.1007/s00535-011-0398-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 03/08/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prognosis of patients who have hepatocellular carcinoma (HCC) associated with inferior vena cava tumor thrombus (IVCTT) is very poor, and effective treatment modalities are extremely limited. The objective of this study was to determine the therapeutic efficacy of particle radiotherapy for HCC with IVCTT. METHODS Between June 2001 and January 2009, 16 evaluable patients who had HCC with IVCTT were treated with particle radiotherapy. They were divided into 2 groups: 6 were treated with curative intent; 10 with palliative intent. The local tumor control rates, overall survival rates, and toxicities were evaluated. RESULTS All tumors treated with particle radiotherapy remained controlled without local recurrence at the last follow-up. The overall survival rates for the 16 patients at 1 and 3 years were 61.1 and 36.7%, respectively. We observed a significant difference in the survival rates according to treatment policy. The median survival time was 25.4 months for patients treated with curative intent and 7.7 months for those treated with palliative intent. The one-year survival rates were 100.0 and 33.3%, respectively. No Grade 3 or higher treatment-related toxicities were observed. CONCLUSIONS Particle radiotherapy is thought to be potentially effective and safe for HCC with IVCTT. Considering the current lack of effective and less-invasive local therapy for HCC with IVCTT, particle radiotherapy may therefore be an attractive new therapeutic approach for this type of HCC.
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35
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Meinardus S, Mehlhorn U, Kasper-König W, Senbaklavaci O, Poetini L, Vahl C. Seltene Ursachen akuter, chirurgisch-interventionsbedürftiger Lungenembolien. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2011. [DOI: 10.1007/s00398-011-0845-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Manifestaciones intratorácicas del cáncer de mama. RADIOLOGIA 2011; 53:7-17. [DOI: 10.1016/j.rx.2010.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/22/2010] [Accepted: 07/07/2010] [Indexed: 11/30/2022]
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37
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Intrathoracic manifestations of breast cancer. RADIOLOGIA 2011. [DOI: 10.1016/s2173-5107(11)70001-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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38
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Montagnana M, Cervellin G, Franchini M, Lippi G. Pathophysiology, clinics and diagnostics of non-thrombotic pulmonary embolism. J Thromb Thrombolysis 2010; 31:436-44. [DOI: 10.1007/s11239-010-0519-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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39
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Kuhnert C, Zeca E, Fischer J, Canuet M, Noël E, Rondeau-Lutz M, Weber JC. [Pulmonary hypertension due to tumor embolism]. Rev Med Interne 2010; 31:e6-8. [PMID: 20627477 DOI: 10.1016/j.revmed.2009.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 09/28/2009] [Accepted: 11/08/2009] [Indexed: 10/19/2022]
Abstract
We report a 46-year-old woman with a metastatic breast cancer who developed a subacute pulmonary hypertension. The final diagnosis was microscopic pulmonary neoplastic emboli. She presented with the typical clinical picture of a pulmonary hypertension with a normal pulmonary angiographic computer tomography and multiple sub-segmental perfusion defects on radionuclide imaging. This serious condition must be known by physicians, because of an opportunity to obtain the diagnosis by the cytologic analysis of sampled microvascular blood obtained with a pulmonary artery catheterization. The prognosis is poor and there is no efficient therapy.
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Affiliation(s)
- C Kuhnert
- Service de médecine interne A, Nouvel hôpital civil, hôpitaux universitaires de Strasbourg, 67091 Strasbourg cedex, France
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40
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Das S, Ladell DS, Podgrabinska S, Ponomarev V, Nagi C, Fallon JT, Skobe M. Vascular endothelial growth factor-C induces lymphangitic carcinomatosis, an extremely aggressive form of lung metastases. Cancer Res 2010; 70:1814-24. [PMID: 20179201 DOI: 10.1158/0008-5472.can-09-3675] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The lymphatic system is an important pathway for tumor dissemination to the lymph nodes, but to which extent it contributes to the formation of distant metastases remains unknown. We report that induction of lymphangiogenesis by vascular endothelial growth factor-C (VEGF-C) at the secondary site, in the lung, facilitates expansion of already disseminated cancer cells throughout the lung tissue. By using orthotopic spontaneous metastasis models in nude mice, we show that VEGF-C expression by tumor cells altered the pattern of pulmonary metastases from nodular to diffuse and facilitated disease progression. Metastases expressing VEGF-C were tightly associated with the airways, in contrast to the control cells that were scattered in the lung parenchyma, throughout the alveolar region. VEGF-C induced lung lymphangiogenesis and promoted intralymphatic spread of metastases in the lung and formation of tumor emboli in the pulmonary arteries. This pattern of metastasis corresponds to lymphangitic carcinomatosis metastatic phenotype in human cancer patients, an extremely aggressive pattern of pulmonary metastases. In accordance, pulmonary breast cancer metastases from patients which were classified as lymphangitic carcinomatosis showed high levels of VEGF-C expression in cancer cells. These data show that VEGF-C promotes late steps of the metastatic process and identify the VEGF-C/VEGF receptor-3 pathway as the target not only for prevention of metastases, but also for treatment of established metastatic disease.
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Affiliation(s)
- Suvendu Das
- Department of Oncological Sciences, Mount Sinai School of Medicine, New York, New York 10029, USA
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41
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Rapid fatal outcome from pulmonary arteries compression in transitional cell carcinoma. JOURNAL OF ONCOLOGY 2010; 2009:579407. [PMID: 20111732 PMCID: PMC2810454 DOI: 10.1155/2009/579407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2009] [Accepted: 10/01/2009] [Indexed: 11/18/2022]
Abstract
Transitional cell carcinoma of the urinary bladder is a malignancy that metastasizes frequently to lymph nodes including the mediastinal lymph nodes. This occurrence may produce symptoms due to compression of adjacent structures such as the superior vena cava syndrome or dysphagia from esophageal compression. We report the case of a 59-year-old man with metastatic transitional cell carcinoma for whom mediastinal lymphadenopathy led to pulmonary artery compression and a rapidly fatal outcome. This rare occurrence has to be distinguished from pulmonary embolism, a much more frequent event in cancer patients, in order that proper and prompt treatment be initiated.
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42
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Svanes K. Necrosis of tumour cells related to circulatory insufficiency in pulmonary tumour embolism. ACTA PATHOLOGICA ET MICROBIOLOGICA SCANDINAVICA. SECTION A, PATHOLOGY 2009; 79:553-60. [PMID: 5123512 DOI: 10.1111/j.1699-0463.1971.tb01857.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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43
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Pulmonary Tumor Embolism. J Thorac Oncol 2009. [DOI: 10.1097/jto.0b013e3181a52e8c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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45
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46
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Pulmonary tumor embolism: a rare cause of acute right heart failure with elevated D-dimers. J Thorac Oncol 2009; 3:1482-3. [PMID: 19057276 DOI: 10.1097/jto.0b013e31818e107c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the case of a 49-year-old woman with a prior history of breast cancer who presented with a subacute course of progressive dyspnoea, culminating in cardiovascular collapse from acute right heart failure. D-dimer serum level was elevated. While a computed tomography of the chest was negative for pulmonary embolism, the autopsy study revealed multiple carcinomatous emboli in distal pulmonary arteries, veins, and lymphatics. Pulmonary tumor embolism may be more frequent than previously thought, and could be mistaken for pulmonary thrombo-embolism.
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47
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Dalal PU. Non-metastatic manifestations of cancer in the chest. IMAGING 2008. [DOI: 10.1259/imaging/83642253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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48
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Rastogi R, Garg R, Thulkar S, Bakhshi S, Gupta A. Unusual thoracic CT manifestations of osteosarcoma: review of 16 cases. Pediatr Radiol 2008; 38:551-8. [PMID: 18246342 DOI: 10.1007/s00247-007-0735-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2007] [Revised: 11/25/2007] [Accepted: 12/13/2007] [Indexed: 11/30/2022]
Abstract
Pulmonary metastases are common in osteosarcoma and the most common appearance is of multiple well-defined nodules in the lung parenchyma. However, a variety of atypical locations and presentations of osteosarcoma metastasis can occur in the thorax. We present a review of the thoracic CT findings in 16 patients with histopathologically confirmed osteosarcoma with unusual thoracic manifestations. The 16 patients were selected out of a total 136 patients who received a chest CT scan for osteosarcoma during a period of 3 years in a tertiary care hospital. Unusual imaging findings included a solitary large ossified lung mass, ossified mediastinal and hilar lymph nodes, an esophagomediastinal fistula, lymphangitic carcinomatosis, pulmonary artery tumor emboli, a solitary large pleural deposit along the major fissure, multiple pleural deposits, diffuse pleural calcification, pneumothorax, diaphragmatic deposits, an isolated chest wall deposit without lung involvement, and primary osteosarcoma of the rib. Our findings of lymphangitic carcinomatosis in a living patient as well as calcified mediastinal lymphadenopathy leading to esophageal fistula are unique in the literature, and there are only a few case reports of our other findings.
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Affiliation(s)
- Ruchi Rastogi
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India 110029.
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49
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Buckley JD, Ouellette DR, Popovich J. Pulmonary Embolism. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Tomashefski JF, Cagle PT, Farver CF, Fraire AE. Pulmonary Vascular Disease. DAIL AND HAMMAR’S PULMONARY PATHOLOGY 2008. [PMCID: PMC7120700 DOI: 10.1007/978-0-387-68792-6_28] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The pulmonary vasculature is an anatomic compartment that is frequently overlooked in the histologic review of lung biopsy samples, other than those obtained specifically to assess pulmonary vascular disease.1 Though often of a nonspecific nature, the histologic pattern of vascular remodeling may at times suggest its underlying pathogenesis and provide clues to the cause of pulmonary hypertension.2 Disproportionately severe vascular pathology may further indicate alternate disease processes, such as congestive heart failure or thromboemboli, contributing to the patient’s overall respiratory condition.
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Affiliation(s)
- Joseph F. Tomashefski
- grid.67105.350000000121643847Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH USA ,grid.411931.f0000000100354528Department of Pathology, MetroHealth Medical Center, Cleveland, OH USA
| | - Philip T. Cagle
- grid.5386.8000000041936877XDepartment of Pathology, Weill Medical College of Cornell University, New York, NY ,grid.63368.380000000404450041Pulmonary Pathology, Department of Pathology, The Methodist Hospital, Houston, TX USA
| | - Carol F. Farver
- grid.239578.20000000106754725Pulmonary Pathology, Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, OH USA
| | - Armando E. Fraire
- grid.168645.80000000107420364Department of Pathology, University of Massachusetts Medical School, Worcester, MA USA
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