title: Treatment of Pulmonary Tumor Embolism from Choriocarcinoma: Extracorporeal Membrane Oxygenation as a Bridge through Chemotherapy.
abstract: A 22-year-old woman with a 1-month history of shortness of breath that was treated as a case of tuberculosis and pulmonary embolism was referred to the authors' hospital. Because of the hemodynamic instability in this patient, venoarterial extracorporeal membrane oxygenation (ECMO) was administered in the intensive care unit. She underwent a pulmonary embolectomy for the treatment of progressive circulatory collapse secondary to a pulmonary embolism. The histopathologic result was consistent with a metastatic choriocarcinoma. Despite the surgical management, persistent refractory cardiogenic shock occurred. Subsequently, the patient was treated with chemotherapy in the presence of ECMO and responded well to chemotherapy. She was discharged after 3 months. This case suggests that metastatic choriocarcinoma should be considered as a differential diagnosis in women of childbearing age presenting with a pulmonary embolism, and ECMO may be beneficial in patients with pulmonary embolism for bridging to surgical embolectomy and chemotherapy.
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Jae Heun
authors.initials: JH
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hye Ju
authors.initials: HJ
authors.lastname: Yeo
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Hyun Myung
authors.initials: HM
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Jin Ook
authors.initials: JO
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Byung Min
authors.initials: BM
authors.lastname: Ye
authors.affiliation: Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Gun
authors.initials: G
authors.lastname: Yoon
authors.affiliation: Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Dohyung
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea.
authors.forename: Woo Hyun
authors.initials: WH
authors.lastname: Cho
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor; D001784:Blood Gas Analysis; D002822:Choriocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000072226:Computed Tomography Angiography; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor
keywords: Choriocarcinoma; Extracorporeal membrane oxygenation; Pulmonary embolism