title: [Acute cor pulmonale, a rare manifestation of carcinomatous lymphangiosis and hemangiosis].
abstract: METHODS
  A 33-year-old previously healthy woman developed acute cor pulmonale after nonspecific prodromal symptoms. Findings on echocardiography and computed tomography, elevated levels of d-dimers and progressively increased lactate dehydrogenase suggested recurrent small pulmonary emboli.
  
  
  METHODS
  She was given i.v. heparin, but her condition abruptly deteriorated and, despite high-dosage fibrinolysis, she died in cardiopulmonary shock. Autopsy revealed chronic cor pulmonale and widely metastasized gastric carcinoma. Pulmonary embolism was excluded as the cause of death.
  
  
  CONCLUSIONS
  Even currently available diagnostic means may fail to reveal advanced malignant disease, and the early diagnosis of gastric cancer remains a challenge. This case is also a reminder that autopsy may disprove a supposedly definite clinical diagnosis.
authors.affiliation: Medizinische Klink, Enzkreis-Kliniken Mühlacker, Germany. guidokleine@web.de
authors.forename: G
authors.initials: G
authors.lastname: Kleine
authors.forename: B
authors.initials: B
authors.lastname: Feinauer
mesh_terms: D000208:Acute Disease; D000328:Adult; D001344:Autopsy; D005260:Female; D006801:Humans; D008039:Linitis Plastica / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D011660:Pulmonary Heart Disease / Q000000981:diagnostic imaging / Q000209:etiology*; D013902:Radiography, Thoracic; D012770:Shock, Cardiogenic / Q000209:etiology; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D014057:Tomography, X-Ray Computed