Acute Pulmonary Embolism as the First Manifestation of Hepatocellular Carcinoma Complicated with Tumor Thrombi in the Inferior Vena Cava: Surgery or Not?

Excerpt

Acute pulmonary embolism as the first manifestation of hepatocellular carcinoma (HCC) complicated with tumor thrombi in the inferior vena cava (IVC) and right atrium is rare [1]. These patients usually die within a short period because of pulmonary embolism, heart failure, or cancer progression [2]. Here, we describe a 57-year-old man who had HCC complicated with tumor thrombi and pulmonary embolism. He was initially unwilling to undergo surgery but agreed to the surgery after developing a tumor thrombus of the right atrium followed within 24 hr by acute respiratory failure. He died from complications arising from surgery. We reviewed published reports of 14 patients who had HCC and pulmonary embolism. The 1-year survival rate was higher for patients who underwent surgery (40%) than for patients who did not undergo surgery (0%). Therefore, hepatic resection and removal of tumor thrombi should be considered to prolong the patient’s life span. …