Pulmonary Vascular Disease: Pulmonary Vascular Disease |

Massive Pulmonary Embolism as the First Clinical Manifestation of Lung Carcinoma in 40-Year-Old Man FREE TO VIEW

Barbara Rybacka-Chabros, MD
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Medical University of Lublin, Lublin, Poland

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A500. doi:10.1016/j.chest.2016.02.522
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SESSION TITLE: Pulmonary Vascular Disease

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Lung carcinoma is the solid tumor, strongly connected with hemostatis disturbances development. Activation of coagulation system depends both on carcinogenesis and anti-cancer treatment like chemotherapy and radiotherapy. Early stages of lung carcinoma are often clinically silent. This case ilustrates the situation when the massive pulmonary embolism was the first clinical manifestation of lung carcinoma in 40 years old man.

CASE PRESENTATION: 40 years old, without any medical history, non-smoking man, admitted to the emergency room becouse acute severe dyspnoe, chest pain and haemoptysis. Myocardial infarction was excluded. Spiral computed tomography showed massive pulmonary embolism and the tumor localized in the middle lobe of right lung and two small metastatic changes in the left lung. Patient received the proper antithrombotic medication. After two weeks of treatment, he underwent bronchoscopy, and non-small cell lung carcinoma was diagnozed. Patient was qualified to oncologic regimen including platinum-based chemotherapy like cisplatin and vinorelbin combined, and consequtive radiotherapy. Progression free survival was 5 months. After progression, patient received second-line chemotherapy including karboplatin and paklitaxel. After the next 12 month patient died becouse lung cancer local progression and liver metastases

DISCUSSION: Until today, there is no screening protocol to diagnose the early stages of lung carcinoma. In majority cases, lung cancer is diagnosed in stage III B or IV, too late for surgery. Sometimes, additional clinical symptoms, strongly connected with carcinogenesis, like blood coagulation system disturbances, occuring earlier than the main disease. In our study case, the patient was not any medical history before pulmonary embolism clinical manifestation.

CONCLUSIONS: The coexistance of lung carcinoma and pulmonary embolism is the bad prognostic factor. In patients with pulmonary embolism diagnosis, oncological watchfullness should be recomended.

Reference #1: Lee JW, Chor SI, Jung CY et al. Clinical course of pulmonary embolism in lung cancer patients. Respiration 2009; 78 (1): 42-48

Reference #2: Nichols L, saunders R, Fredrich D et al.: Causes of death of patients with lung cancer. Arch Pathol Lab med 2012; 136: 1551-1557

Reference #3: Chuang YM, YU CJ; Clinical characteriscics and outcomes of lung cancer and pulmonary embolism Oncology 2009; 77 (2): 100-106

DISCLOSURE: The following authors have nothing to disclose: Barbara Rybacka-Chabros

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