P1451 Massive fatal venous thrombosis

Abstract

We present the case of a 63-year old woman with previous history of high-grade liposarcoma. of the lower extremity. She had been treated with radiotherapy and chemotherapy and then she underwent surgical treatment with wide local excision several months ago. She was awaiting a new surgical procedure to remove a right suprarrenal metastasis. The patient presented with lower extremity edema and abdomen and increasing weight in the previuos week. A thoracic and abdominal CT showed the suprarrenal mass had become of greater size. Enlargement of superior vena cava, partial filling defects in several segments of the right lung suggestive of acute pulmonary embolism. Extensive thrombosis from right iliac vein, common iliac vein, intrahepatic cava vein, inferior vena cava, right atrium and right ventricle. Bilateral pleural effusion and ascites. A transthoracic echocardiogram revealed a big mass (6.1 cm) in the right atrium prolapsing into the right ventricle. There was a mean diastolic gradient of 3 mmHg and maximal gradient of 6 mmHg in the tricuspid valve. Left ventricle systolic function was moderately depressed due to abnormal movement of the interventricular septum suggestive of pulmonary hypertension. The clinical course was characterized by rapid deterioration and the patient died from cardiogenic shock. The source of thrombi in the right side of the heart most of the times is venous thrombi that have embolized. Cancer patients have an increased risk of venous thromboembolism compared with the general population. The risk varies depending on the type and the stage of the cancer. Metastatic disease has the highest risk. Most clinically significant pulmonary embolisms originate as venous thromboembolism in the lower extremities or pelvic veins. However in most of the cases it is difficult to image the thrombus "in-transit". In this case the most striking feature is not imaging the thrombus "in-transit" but its massive size. Abstract P1451 Figure. liposarcoma Euro Echo 2019