EXTENSIVE PULMONARY THROMBOEMBOLISM AS FIRST SIGN OF A LUNG CANCER - CASE REPORT
A. Bondaryev (1), D. Makris (2), E. Zakynthinos (2), Luminiţa Lucaci (1), Oana Florea (1)
(1) Centre Hospitalier “Dr. Schaffner” Lens, Departament of Pulmonology, France
(2) Critical Care Department, School of Medicine, University Hospital of Thessaly, Greece
Jurnalul de chirurgie 2011; 7 (4): 668-672
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Abstract:

Background: The malignancies increase the risk for thromboembolic disease, which may be present as an additional clinical entity or as a first sign in a patient with occult neoplastic disease. Case Report: We present the case of a 45 years old man initially admitted in emergency due to dyspnea, hypoxemia and hemoptysis. The CT scan and ultrasound exam diagnosed a thromboembolism. The anticoagulant therapy was performed. After one month the patient was readmitted for the same symptoms and the CT scan revealed an atelectatic opacity in the base of the left lung and extension of the thromboembolic disease in the superior vena cava and right atrium. The bronchoscopy including ultrasound and biopsy revealed an adenocarcinoma and adenopathies (stage IIIB - T2N3M0). Chemotherapy has been initiated and, after 3 cycles, partial regression of the tumor and significant regression of thromboembolic disease were revealed. However, both malignant and thrombembolic disease recurred within 6 months, despite optimum anticoagulation and completion of 6 chemotherapy cycles and the patient died 7 months after initial diagnosis. Conclusions: The present case demonstrates potential difficulties in the management of thromboembolic disease in patients with lung malignancies where the usual treatment with anticoagulants may fail. The management of the primary disease by chemotherapy may provide a transient regression of thromboembolic symptoms if malignancy regresses. However, definitive control of the disease is difficult to achieve in these cases.

KEY WORDS: THROMBOEMBOLISM, LUNG CANCER

Correspondence to: A. Bondaryev, MD, Centre Hospitalier “Dr. Schaffner” Lens, Department of Pulmonology, 99, Route de la Bassée, 62300, LENS, France; phones: +33(0) 32 16 91 093; +33(0) 32 16 91 619; Fax: +33(0) 32 16 91 325, e-mail: