Pulmonary embolism as the presenting feature of hepatocellular carcinoma.
Presse Med
; 23(10): 474-6, 1994 Mar 12.
Article
en En
| MEDLINE
| ID: mdl-8022723
Primary hepatocellular carcinoma can be revealed by recurrent pulmonary embolism as observed in this case of a 63-year-old woman initially hospitalized for abdominal pain and shortness of breath. The clinical diagnosis was confirmed by laboratory findings, a ventilation perfusion scan and pulmonary angiography which demonstrated peripheral basal artery cut-off and slow filling with delayed washout. The patient was treated with heparin then with nicoumarol and responded well. One month after discharge the patient again complained of shortness of breath and was readmitted. Anticoagulation was adequate as evidenced by a prothrombin time of 1.39 INR and the physical examination and laboratory tests again suggested pulmonary emboli, confirmed by a ventilation perfusion scan. Computed tomography of the chest and abdomen revealed multiple hypodense masses filling half of the liver volume and needle biopsy led to the diagnosis of hepatocellular carcinoma. Hypercoagulability in malignancy is well-known although cases of migratory thrombophlebitis are extremely rare. Pulmonary embolism has not been described as a presenting feature of hepatocellular carcinoma. In this case, there was no evidence of hepatic dysfunction and the pulmonary embolism occurred despite adequate anticoagulation. Clinicians should include occult carcinoma among the possible causes of recurrent pulmonary embolism and when searching for malignancy can include hepatocellular carcinoma among the causes of hypercoagulation.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Embolia Pulmonar
/
Carcinoma Hepatocelular
/
Neoplasias Hepáticas
Límite:
Female
/
Humans
/
Middle aged
Idioma:
En
Revista:
Presse Med
Año:
1994
Tipo del documento:
Article
País de afiliación:
Israel
Pais de publicación:
Francia