Korean J Pediatr.  2012 Jul;55(7):249-253. 10.3345/kjp.2012.55.7.249.

A fatal case of acute pulmonary embolism caused by right ventricular masses of acute lymphoblastic lymphoma-leukemia in a 13 year old girl

• Ko YM
• Lee SH
• Huh J
• Koo HH
• Yang JH

• KMID: 1433738
• DOI: http://doi.org/10.3345/kjp.2012.55.7.249

Abstract

We report a case of a 13-year-old girl with acute lymphoblastic lymphoma-leukemia, who presented with a cardiac metastasis in the right ventricle, resulting in a pulmonary embolism. At the time of her leukemia diagnosis, a cardiac mass was incidentally found. The differential diagnosis for this unusual cardiac mass included cardiac tumor, metastasis, vegetation, and thrombus. Empirical treatment was initiated, including anticoagulation and antibiotics. She underwent plasmapheresis and was administered oral prednisolone for her leukemia. Five days later, she experienced sudden hemodynamic collapse and required extracorporeal membrane oxygenation insertion and emergency surgery. These interventions proved futile, and the patient died. Pathology revealed that the cardiac mass comprised an aggregation of small, round, necrotic cells consistent with leukemia. This is the first known case of acute lymphoblastic leukemia presenting as a right ventricular mass, with consequent fatal acute pulmonary embolism. A cardiac mass in a child with acute leukemia merits investigation to rule out every possible etiology, including vegetation, thrombus, and even a mass of leukemic cells, which could result in the fatal complication of pulmonary embolism.

Keyword

Leukemia; Metastasis; Pulmonary embolism; Child

MeSH Terms

Adolescent
Anti-Bacterial Agents
Child
Diagnosis, Differential
Emergencies
Extracorporeal Membrane Oxygenation
Heart Neoplasms
Heart Ventricles
Hemodynamics
Humans
Leukemia
Neoplasm Metastasis
Plasmapheresis
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prednisolone
Pulmonary Embolism
Thrombosis
Anti-Bacterial Agents
Prednisolone