Abstract
We describe a 35-year-old man who had a pulmonary embolism with thrombosis of the inferior vena cava, apparently resulting from compression by a hepatic hemangioma. The diagnosis of pulmonary embolism was confirmed by pulmonary angiography; however, the hemangioma was detected only incidentally, as a hyperechoic mass, during an echocardiogram for intracardiac thrombosis. Abdominal sonography, computed tomography, celiac angiography, technetium 99m-labeled red blood cell scintigraphy, and ultrasound-guided liver biopsy all assisted in the diagnosis of hepatic hemangioma and its compression of the inferior vena cava. Because of the multisegmental and perihilar involvement of the tumor, surgery was not performed. For dissolution of the clots, the patient was given thrombolytic therapy followed by heparin administration. He was then placed on long-term warfarin therapy and is well after 5 years; the size of the hemangioma is unchanged. Cases of pulmonary embolism due to diseases of the upper abdominal organs are rare and probably underestimated. This case stresses the need for a systematic investigation of the abdomen when a pulmonary embolism is present without evidence of deep vein thrombosis.
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- COOPER W. H., MARTIN J. F. Hemangioma of the liver with thrombocytopenia. Am J Roentgenol Radium Ther Nucl Med. 1962 Oct;88:751–755. [PubMed] [Google Scholar]
- Davis W. D., Ferrante W. A., Tutton R. H., Bowen J. C. Hepatic hemangioma with normal angiograms. Three case reports. JAMA. 1990 Feb 16;263(7):983–986. [PubMed] [Google Scholar]
- Dennis P. M. Fatal pulmonary embolism due to thrombosis of a hepatic cavernous haemangioma. Med Sci Law. 1980 Oct;20(4):287–288. doi: 10.1177/002580248002000410. [DOI] [PubMed] [Google Scholar]
- Kato M., Sugawara I., Okada A., Kuwata K., Satani M. Hemangioma of the liver. Diagnosis with combined use of laparoscopy and hepatic arteriography. Am J Surg. 1975 Jun;129(6):698–703. doi: 10.1016/0002-9610(75)90350-5. [DOI] [PubMed] [Google Scholar]
- Khurana B. K., Friedman S. A. Occult inferior vena cava thrombosis: diagnosis by sonography--case reports. Angiology. 1991 Feb;42(2):162–166. doi: 10.1177/000331979104200213. [DOI] [PubMed] [Google Scholar]
- Kolarski V., Dimitrova B., Chemishanski G. Tumorna belodrobna emboliia pri pŭrvichen rak na cherniia drob. Vutr Boles. 1990;29(2):84–88. [PubMed] [Google Scholar]
- Moser K. M. Venous thromboembolism. Am Rev Respir Dis. 1990 Jan;141(1):235–249. doi: 10.1164/ajrccm/141.1.235. [DOI] [PubMed] [Google Scholar]
- Parienty R. Computed tomography in the diagnostic approach to cavernous hemangioma of the liver. Radiology. 1980 Feb;134(2):553–554. doi: 10.1148/radiology.134.2.7352254. [DOI] [PubMed] [Google Scholar]
- Patel N., Krasnow A. Z., Collier B. D., Hellman R. S., Isitman A. T. Pulmonary embolism as an indicator of occult malignancy. Clin Nucl Med. 1990 Nov;15(11):841–842. doi: 10.1097/00003072-199011000-00016. [DOI] [PubMed] [Google Scholar]
- SEWELL J. H., WEISS K. Spontaneous rupture of hemangioma of the liver. A review of the literature and presentation of illustrative case. Arch Surg. 1961 Nov;83:729–733. doi: 10.1001/archsurg.1961.01300170085016. [DOI] [PubMed] [Google Scholar]
- Shinzato J., Yamashita Y., Takahashi M., Miura K. [A case of pulmonary infarction secondary to emboli of hepatoma]. Rinsho Hoshasen. 1990 Aug;35(8):971–974. [PubMed] [Google Scholar]
- Slovis T. L., Berdon W. E., Haller J. O., Casarella W. J., Baker D. H. Hemangiomas of the liver in infants. Review of diagnosis, treatment and course. Am J Roentgenol Radium Ther Nucl Med. 1975 Apr;123(4):791–801. doi: 10.2214/ajr.123.4.791. [DOI] [PubMed] [Google Scholar]
- Taavitsainen M., Airaksinen T., Kreula J., Päivänsalo M. Fine-needle aspiration biopsy of liver hemangioma. Acta Radiol. 1990 Jan;31(1):69–71. [PubMed] [Google Scholar]