Pulmonary embolism (PE) related to the presence of right heart thromboemboli entails a higher mortality rate than PE alone. Furthermore, right heart thromboemboli are often associated with deep venous thrombosis. The most effective therapy for haemodynamically stable patients remains unknown, although recent data suggest that thrombolytic therapy is associated with a better outcome. We describe the case of an 83-year-old woman, hospitalized with PE consequent to right heart thrombus-in-transit, in whom investigation revealed a concomitant deep venous thrombosis. She required thrombolysis, given the high mortality risk that is traditionally associated with this clinical entity.
LEARNING POINTS• Pulmonary embolism secondary to right-sided cardiac thromboembolus entails a higher mortality rate than PE alone.
his legs. His primary laboratory investigation showed anemia, monocytosis, eosinophilia and thrombocytopenia,. He also had elevated serum creatinine (4.4 mg/dl) and LDH(430U/L) values respectively. His prior creatinine level was normal. His urine analysis showed 28 erythrocytes/ hpf. Calculated proteinuria was 750 mg/day. Urinary ultrasound examination was normal. Protein electrophoresis showed hyper gamma globulinemia 1.73 g/dl. Leucocytoclastic vasculitis was revealed by punch biopsy of skin. All serologic workup was normal except for low C3 levels (77 mg/dl). Bone marrow biopsy and renal fine needle biopsy was performed. Bone marrow biopsy showed peritrabecular and intertrabecular lymphoid nodules consisting of CD20, CD5, Bcl-1 positive atypical lymphoid cells regarded as neoplastic infiltration. Renal biopsy showed intravascular and interstitial atypical lymphoid cells as groups of 4-5 cells. These atypical lymphoid cells were CD20, CD5 Pax-5 and Bcl-1 positive. Pathological and immune-histochemical findings of biopsies were consistent with MCL. Positron emission tomography determined iliac, obturatory lymph nodes and avidity at renal hilum level. Patient was planned to receive 6 cures of Rituximab, cyclosporine, hydroxydaunorubicine, oncovine, prednisone. After first R-CHOP cure he suffered a massive pulmonary emboli and died. Conclusions: Infiltration of renal parenchyma by lymphoma cells is very rare and is rated in about 1 % of cases. There are only three cases of renal MCL infiltration with ARF. Our case is the fourth case of MCL presenting with ARF due to neoplastic cell infiltration while this is the first case that neoplastic MCL cells to be shown in the lumen of renal vessels, capillaries. The case demonstrates for the first time the possibility of intravascular renal infiltration by MCL. It also revealed the importance of the renal biopsy as a useful diagnostic choice in case of kidney impairment in lymphoma patients.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.