Emergency Management of a Particular Massive Pulmonary Embolism…

Abstract

Cardiac intracavitary metastasis is very uncommon. In a 55-year-old man presenting with a massive pulmonary embolism pattern, transthoracic echocardiography (TTE) allowed us to visualize an isolated right ventricular metastasis extended into the pulmonary trunk. It led to the discovery of a primary testis embryonal carcinoma. No intracaval and right atrial localization was observed. Despite an urgent complete cardiac metastasis resection and concomitant orchidectomy, TTE showed on postoperative day 6 an uncommon total intracardiac regrowth spreading again to the pulmonary trunk. Combination chemotherapy (etoposide, cisplatin, and bleomycin) was immediately undertaken. This is the first well-documented case of an isolated right ventricular germ-cell cancer metastasis extended into the pulmonary trunk, without intracaval and right atrial involvement, where the outcome was marked with immediate regrowth despite cardiac surgery and orchidectomy. In conclusion, TTE should be considered alongside germ-cell cancer standard staging procedures.

A young testicular cancer case presenting with an inferior vena cava thrombosis and bilateral pulmonary embolisms

“…[3,7,8] Hoshino ve ark. [7] pulmoner emboli gelişen testis tümörlü bir olgunun postmortem otopsisinde pulmoner arter intimasında tümör hücre metastazı ve diseksiyon bildirmiştir.…”

“…Talha ve ark. [3] akut massif pulmoner emboli kliniği ile başvuran bir olguda transözofagial ekokardiyografi ile izole olarak sağ ventrikülden pulmoner trunkusa uzanan ve cerrahi diseksiyon sonrası tümör metastazı olduğu saptanan ve testis tümörü tanısı alan bir olguyu bildirdiler. Olguda VKİ ve sağ atriumda yayılım mevcut değildi.…”

Right Ventricular Variants and Pulmonary Embolism—Association or Coincidence?

“…The primary tumors include myxomas9 and papillary fibroelastomas,10 whereas testicular embryonal carcinoma11 and squamous cervical carcinoma12 are examples of metastatic right ventricular tumors with resultant pulmonary emboli.…”

“…The right side of the heart as the source of pulmonary emboli is not a new concept: Various primary and secondary cardiac tumors have been shown to be a potential source of pulmonary emboli. 9–12 The primary tumors include myxomas 9 and papillary fibroelastomas, 10 whereas testicular embryonal carcinoma 11 and squamous cervical carcinoma 12 are examples of metastatic right ventricular tumors with resultant pulmonary emboli.…”