Acute aortic occlusion due to tumor embolism in a patient with lung malignancy

Abstract

Objectives:Acute lower limb ischemia caused by tumor embolization is rare, despite the fact that cancer is a common cause of hypercoagulability predisposing to venous thrombosis. Arterial embolization is mostly associated with intracardiac tumors while lung malignancies are the second most common cause of tumor embolism.Methods:In this report, we present a male patient who developed acute bilateral lower limb ischemia in the immediate postoperative period after a thoracotomy for attempted left upper lobe resection for lung cancer.Results:The patient was treated with a subclavian-bifemoral bypass, since an initial attempted embolectomy was unsuccessful. Histopathological characteristics of thrombus obtained during embolectomy were consistent with the histopathology of the primary tumor.Conclusion:Acute ischemia is an emergency that should be diagnosed and treated immediately. Interestingly, in this case, the presence of epidural anesthesia masked the initial symptoms and delayed diagnosis. Preoperative assessment with transesophageal echocardiography may reveal patients at high risk for tumor embolism.

Acute mesenteric ischemia leading to diagnosis of advanced spindle cell carcinoma of the lung

“…The embolization of tumor fragments significant enough to cause ischemia, however, is a rare event. 1 , 2 , 3 , 4 , 5 , 6 , 7 The first case was described in 1981 by Starr et al. 1 Compared with ischemic events that occur from unknown malignant sources, those from known malignant sources have been more widely recognized for two main reasons.…”

“…Nearly all reports of systemic arterial embolization in patients with any primary malignancy have discussed the mechanism by which pulmonary metastases, pulmonary primary tumors, or cardiac malignancies invade the pulmonary veins (PVs), fragment within the left atrium or within the PVs and subsequently enter the systemic circulation. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Another recognized mechanism is when the heart or aorta has been directly invaded by the tumor owing to proximity, achieving direct access to the arterial circulatory system. 4 , 5 , 6 , 7 , 8 , 9 Finally, in patients with known invasive lung cancer undergoing surgery, it has been reported that surgical manipulation of the PVs can result in arterial embolization.…”

“… 4 , 5 , 6 , 7 , 8 , 9 Finally, in patients with known invasive lung cancer undergoing surgery, it has been reported that surgical manipulation of the PVs can result in arterial embolization. 7 , 8 , 9 …”

“…When this occurs, the approach has often been to categorize the potential sources into myxomatous and nonmyxomatous. 1 , 2 , 3 , 4 , 7 , 9 It has been reported that 30% to 45% of unresected left atrial myxomas can fragment and embolize. 3 , 7 In those with no known history of myxoma or malignancy, it appears that the primary diagnosis of pulmonary malignancy has been most common.…”

“… 1 , 2 , 3 , 4 , 7 , 9 It has been reported that 30% to 45% of unresected left atrial myxomas can fragment and embolize. 3 , 7 In those with no known history of myxoma or malignancy, it appears that the primary diagnosis of pulmonary malignancy has been most common. 1 , 3 , 5 , 7 , 8 Anatomically, this makes sense in terms of the mechanism of PV invasion.…”