SHM Converge Scientific Abstract ePoster Gallery-A Clot or a Rock

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This case report describes a rare non-thrombotic pulmonary embolism caused by tumor embolism from hepatocellular carcinoma (HCC), emphasizing how it can closely mimic pulmonary thromboembolism (PTE). Non-thrombotic pulmonary embolism may result from tumor cells, air, amniotic fluid, or septic material, and is often difficult to distinguish from a clot because symptoms and imaging findings can be similar.<br /><br />An 80-year-old woman with a history of breast cancer and HCC presented with chest pain and worsening shortness of breath on exertion. CT imaging of the chest and abdomen revealed a mass in the right ventricle extending into the main pulmonary artery, along with signs of right heart strain, initially raising concern for acute pulmonary embolism. CT of the abdomen also showed multiple hypodense liver lesions, suggesting progression of her known HCC. She was started on anticoagulation and underwent suction thrombectomy, but the procedure was aborted because the mass was rigid and difficult to aspirate, causing acute blood loss. Subsequent cardiac MRI showed a highly vascular, heterogeneous mass in the right ventricle and pulmonary artery, concerning for malignancy. Pathology from the thrombectomy specimen confirmed metastatic HCC.<br /><br />The discussion highlights that tumor embolism can occur when solid tumors shed cells or fragments into the circulation, leading to vascular obstruction. Although reported in several cancers, macroscopic tumor embolism from HCC is extremely rare. Misdiagnosis as PTE can be dangerous, especially if thrombolytics are given, as this may cause catastrophic hemorrhage. Treatment is usually palliative chemotherapy, but prognosis is poor due to advanced disease.<br /><br />Key takeaway: in patients with solid tumors and acute or subacute dyspnea, tumor embolism should be considered in the differential diagnosis before treating presumed pulmonary embolism.

Asset Subtitle

Pavneet Kaur

Meta Tag

Author List Jaydeep Patel, Juan Sarmiento, Pavneet Kaur, Saminder Kalra

Category Clinical Vignettes

Concept Non-Thrombotic Pulmonary Embolism

Concept Tumor Embolism

Concept Thromboembolism

Concept Hepatocellular Carcinoma

Concept Macroscopic Pulmonary Tumor Embolism

Distinguished Finalist

Presenter Organization University of Florida Health Shands Hospital

Presenting Author Pavneet Kaur

Track Adult

Keywords

hepatocellular carcinoma

tumor embolism

non-thrombotic pulmonary embolism

pulmonary thromboembolism

right ventricular mass

pulmonary artery obstruction

cardiac MRI

metastatic HCC

suction thrombectomy

dyspnea

Non-Thrombotic Pulmonary Embolism

Tumor Embolism

Thromboembolism

Hepatocellular Carcinoma

Macroscopic Pulmonary Tumor Embolism