The Virtual Hospital: ElectricPE: The Diagnosis of Pulmonary Embolism: Renal Carcinoma

ElectricPE: The Diagnosis of Pulmonary Embolism: Case Study 11

Renal Carcinoma

Jeffrey R. Galvin, M.D. and James J. Choi, B.S.
Peer Review Status: Internally Reviewed

This case was a 50 year old male alcoholic with a 75 pack year history of smoking who presented to the hospital with a 2 week history of cough productive of greenish sputum, ÒatypicalÓ chest pain and dyspnea on exertion. His physical exam revealed an enlarged, tender liver. He was treated for pneumonia based on his symptoms.

The chest radiograph revealed a small right sided pleural effusion. Both diaphragms were flattened suggesting the presence of emphysema.

The abdominal CT revealed a large left adrenal mass that was biopsied. The biopsy was read as adenocarcinoma of uncertain origin. In addition, a large thrombus was found in the left renal vein and the IVC.

A chest CT slice obtained through the mediastinum revealed a clot extending into the descending portion of the left main pulmonary artery.

Case Assessment
This is a 50 year old alcoholic with a long history of smoking cigarettes presents with a cough, chest pain , dyspnea, purulent sputum and an enlarged liver.

1. The patient demonstrates that deep venous thrombosis and pulmonary embolus can be the presenting signs and symptoms in a patient with adenocarcinoma. These patients may be hypercoagulable.

2. Although the source of most emboli is the deep venous system of the legs, clots may originate from other areas including the renal veins, the arm veins, the right atrium and the right ventricle.

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