Multiple instances of peripheral artery emboli from occult primary small cell lung cancer.
Most peripheral artery emboli originate in the heart, and systemic neoplastic emboli are infrequently associated with bronchogenic carcinoma. To our knowledge, there have been no reports of pulmonary vein infiltration by small cell lung cancer.We describe a highly unusual case of multiple instances of peripheral embolism as the first overt sign of occult primary small cell lung cancer. Tumor emboli infiltrated the pulmonary veins of a 62-year-old man who presented first with a transient ischemic attack and then with other ischemic symptoms. The uncommonly wide distribution of tumor emboli over a short time resulted in death.Improvements in diagnostic imaging have led to the early identification of relatively isolated small cell lung cancers. This patient's case underscores the importance of transesophageal echocardiography in detecting cardiac emboli when the cause of cerebral ischemic attack is unknown or if there might be multiple instances of arterial embolism. Computed tomography also has a role in the investigation of possible sources of emboli and unrecognized, asymptomatic embolization.
Department of Vascular & Endovascular Surgery, Policlinico Casilino in Rome, 00169 Rome, Italy. rogadoc@libero.it
Roberto
R
Gabrielli
Maria Sofia
MS
Rosati
Roberto
R
Chiappa
Silvio
S
Vitale
Massimiliano
M
Millarelli
Giovanni
G
Caselli
D001344:Autopsy; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D017128:Embolectomy; D004617:Embolism / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D007511:Ischemia / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000209:etiology; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology*; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome