A Trilogy of Submassive Pulmonary Embolism, Non-Small Cell Lung Cancer with Brain Metastasis, Kartagener’s Syndrome and its Management with Aspiration Thrombectomy
  • Vinit Singh
    Internal Medicine Department, Monmouth Medical Center, Long Branch, NJ, USA
  • Dhairya Gor
    Internal Medicine Department, Jersey Shore University Medical Center, Neptune City, NJ, USA
  • Rana Prathap Padappayil
    Internal Medicine Department, Monmouth Medical Center, Long Branch, NJ, USA
  • Ali Jaffery
    Internal Medicine Department, Monmouth Medical Center, Long Branch, NJ, USA
  • Patrick Lee
    Internal Medicine Department, Monmouth Medical Center, Long Branch, NJ, USA

Keywords

Submassive pulmonary embolism, non-small cell lung cancer, bleeding risk, resection, aspiration thrombectomy

Abstract

Venous thromboembolism is a common cause of morbidity and mortality in cancer patients. Given the bleeding risks, determining treatment for malignancy-related thrombosis is challenging, especially in the case of submassive pulmonary embolism (PE) because the risk-benefit ratio in terms of bleeding risk is uncertain. Here we discuss the case of a 53-year-old man with Kartagener syndrome with situs inversus totalis and stage IV non-small cell lung cancer with a recent brain mass resection, presenting with dyspnoea and palpitations. The patient was diagnosed with a submassive PE and only underwent suction thrombectomy through the left internal jugular vein with excellent response. In conclusion, when treating submassive PE, aspiration thrombectomy without thrombolysis is preferable to thrombolysis, which may be contraindicated due to the higher risk of bleeding.

VIEW THE ENTIRE ARTICLE

References

  • Mulder FI, Horváth-Puhó E, van Es N, van Laarhoven HWM, Pedersen L, Moik F, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood 2021 Apr 8;137(14):1959–1969. Available from: https://pubmed.ncbi.nlm.nih.gov/33171494/
  • Gupta R, Ammari Z, Dasa O, Ruzieh M, Burlen JJ, Shunnar KM, et al. Long-term mortality after massive, submassive, and low-risk pulmonary embolism. Vasc Med 2020 Apr 1;25(2):141–149. Available from: https://pubmed.ncbi.nlm.nih.gov/31845835/
  • Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, et al. 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014 Nov 14;35(43):3033–3069, 3069a–3069k. Available from: https://pubmed.ncbi.nlm.nih.gov/25173341/
  • Tu T, Toma C, Tapson VF, Adams C, Jaber WA, Silver M, et al; FLARE Investigators. A prospective, single-arm, multicenter trial of catheter-directed mechanical thrombectomy for intermediate-risk acute pulmonary embolism: the FLARE Study. JACC Cardiovasc Interv 2019 May 13;12(9):859–869. Available from: https://pubmed.ncbi.nlm.nih.gov/31072507/
  • Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016 Feb 1;149(2):315–352. Available from: https://pubmed.ncbi.nlm.nih.gov/26867832/
  • Piazza G, Goldhaber SZ. Management of submassive pulmonary embolism. Circulation 2010;122(11):1124–1129. Available from: https://www.ahajournals.org/doi/abs/10.1161/circulationaha.110.961136
  • Chatterjee S, Chakraborty A, Weinberg I, Kadakia M, Wilensky RL, Sardar P, et al. Thrombolysis for pulmonary embolism and risk of all-cause mortality, major bleeding, and intracranial hemorrhage: a meta-analysis. JAMA 2014 Jun 18;311(23):2414–2421. Available from: https://pubmed.ncbi.nlm.nih.gov/24938564/
  • Meyer G, Vicaut E, Danays T, Agnelli G, Becattini C, Beyer-Westendorf J, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014 Apr 10;370(15):1402–1411.
  • McDaniel MC. FLARE: mechanical thrombectomy for intermediate-risk PE. Am Coll Cardiol Jul 31 2018 [accessed 12 Sep 2021]. Available from: https://www.acc.org/latest-in-cardiology/articles/2018/07/31/08/38/flare-mechanical-thrombectomy-for-intermediate-risk-pe
  • Sista AK, Horowitz JM, Tapson VF, Rosenberg M, Elder MD, Schiro BJ, et al. Indigo aspiration system for treatment of pulmonary embolism: results of the EXTRACT-PE trial. JACC Cardiovasc Interv Feb 8 2021;14(3):319–329. Available from: https://pubmed.ncbi.nlm.nih.gov/33454291/
  • Bunc M, Steblovnik K, Zorman S, Popovic APP. Percutaneous mechanical thrombectomy in patients with high-risk pulmonary embolism and contraindications for thrombolytic therapy. Radiol Oncol 2020 Feb 14;54(1):62. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7087421/

    • Views: 461
    HTML downloads: 75
    PDF downloads: 291

    Published: 2022-03-02
    Issue: 2022: Vol 9 No 3 (view)

    How to cite:
    1.
    Singh V, Gor D, Padappayil RP, Jaffery A, Lee P. A Trilogy of Submassive Pulmonary Embolism, Non-Small Cell Lung Cancer with Brain Metastasis, Kartagener’s Syndrome and its Management with Aspiration Thrombectomy. EJCRIM 2022;9 doi:10.12890/2022_003149.