Korean J Obstet Gynecol.  2012 Aug;55(8):606-609. 10.5468/KJOG.2012.55.8.606.

Ovarian cancer with initial symptom of pulmonary embolism: A case report

• Park JW
• Hwang SO
• Lee BI
• Park JH
• Lee JH
• Song E

• KMID: 2078114
• DOI: http://doi.org/10.5468/KJOG.2012.55.8.606

Abstract

Venous thromboembolism often occurs after major surgery and may occur as a consequence of underlying cancer. A 39-year-old woman presented to the emergency room with chief complaints of dyspnea and right chest pain. Chest computed tomography (CT) revealed pulmonary artery thromboembolism of the left lobe and a massive right pleural effusion. D-dimer level was 40.4 microg/mL. Abdomino-pelvic CT revealed a 15x12x14 cm solid and cystic mass in the pelvic cavity, suggesting ovarian cancer. A pleural biopsy found metastatic adenocarcinoma. She underwent cytoreductive surgery and pathologic findings revealed malignant mullerian mixed tumor of ovary. The hypercoagulable state in patients with ovarian cancer may occur as an initial symptom of pulmonary embolism. It is unresponsive to standard anticoagulation therapy. The hypercoagulable state in patient with ovarian cancer may be stopped by cytoreductive surgery of the malignancy.

Keyword

Ovarian cancer; Pulmonary embolism; Venous thromboembolism

MeSH Terms

Adenocarcinoma
Adult
Biopsy
Chest Pain
Dyspnea
Emergencies
Female
Fibrin Fibrinogen Degradation Products
Humans
Mixed Tumor, Mullerian
Ovarian Neoplasms
Ovary
Pleural Effusion
Pulmonary Artery
Pulmonary Embolism
Thorax
Thromboembolism
Venous Thromboembolism
Fibrin Fibrinogen Degradation Products

Figure

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  Fig. 1 Enhanced computed tomography scan of chest showing pulmonary embolism (arrow) and massive right pleural effusion.

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  Fig. 2 Abdomino-pelvic computed tomography showed solid and cystic mass in pelvic cavity (A), and wedge shaped low attenuated lesion in mid pole of left kidney (B).

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  Fig. 3 Brain magnetic resonance angiography showed total obstruction of right proximal middle cerebral artery (arrow).

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  Fig. 4 Trans-esophageal echocardiogram showed some vegetation on mitral valve.

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