29 April 2020 : Case report
Leiomyosarcoma Tumor Embolism Masquerading as Thrombus in Transit
Mistake in diagnosis, Rare disease
Benjamin L. Rosenfeld1ABCDEF*, Riyaz Bashir2AB, Meredith A. Brisco-Bacik2AB, Ioannis P. Panidis2AB, Anjali Vaidya2DE, Kenji Minakata3B, Paul R. Forfia2ABDEGDOI: 10.12659/AJCR.921124
Am J Case Rep 2020; 21:e921124
Abstract
BACKGROUND: Tumor embolism is a rare neoplastic complication that occurs when there is intravenous invasion by a benign or malignant tumor. We present the case of an asymptomatic patient with an incidentally discovered leiomyosarcoma tumor emboli, which was initially misdiagnosed as “thrombus in transit.”
CASE REPORT: The patient was a 58-year-old woman who was incidentally found on echocardiogram to have a large tubular mass within the inferior vena cava and right atrium. Although initially characterized as “thrombus in transit”, this mobile right atrial mass was present without clinical, echocardiographic, or radiographic evidence of pulmonary embolism or increased pulmonary arterial impedance. Given that a thrombus in transit is nearly always associated with submassive or massive pulmonary emboli and their attendant right heart sequelae, these pertinent negative findings led us to seek an alternative diagnosis. After a trial of conservative management with anticoagulation and attempted removal of the mass with the AngioVac system, the patient ultimately underwent median sternotomy and surgical embolectomy on cardiopulmonary bypass to remove the mass, which was later identified on pathology as a leiomyosarcoma.
CONCLUSIONS: With rare exceptions, “thrombus in transit” is accompanied by large pulmonary emboli and the presence of increased pulmonary artery pressure and right heart strain. The absence of clinical, echocardiographic, or radiographic evidence of these hemodynamic sequelae should raise suspicion for an alternative diagnosis. Tumor embolism should be considered in the differential diagnosis of any patient with a history of malignancy who presents with evidence of intracardiac mass or embolism.
Keywords: Neoplastic Cells, Circulating, Pulmonary Embolism, Ventricular Function, Right, Cardiopulmonary Bypass, Diagnosis, Differential, Embolectomy, Heart Atria, Incidental Findings, Leiomyosarcoma, Pulmonary Artery, sternotomy, Thrombosis, Uterine Neoplasms
In Press
14 Mar 2024 : Case report
Laparoscopic Sleeve Gastrectomy with Staple-Line Oversewing in a Patient with Factor XI Deficiency: A Case ...Am J Case Rep In Press; DOI: 10.12659/AJCR.942824
14 Mar 2024 : Case report
Pathogenic Potential of a PCK1 Gene Variant in Cytosolic PEPCK Deficiency: A Compelling Case StudyAm J Case Rep In Press; DOI: 10.12659/AJCR.943118
14 Mar 2024 : Case report
Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Lapa...Am J Case Rep In Press; DOI: 10.12659/AJCR.942826
14 Mar 2024 : Case report
Simultaneous Occurrence of Collagen Type III Glomerulopathy and Immunoglobulin A Nephropathy: A Rare Case R...Am J Case Rep In Press; DOI: 10.12659/AJCR.942770
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250