Two Case Reports Of Cancer With Acute Pulmonary Embolism In Young Adults

Pulmonary embolism (PE) is the second leading cause of death in cancer patients. Despite publication of major consensus guidelines laying out recommendations for diagnosis and treatment of PE in cancer, PE remains misdiagnosed or undiagnosed due to its diverse clinical manifestations, a paucity of literature, and low morbidity in young adults. In order to improve recognition of PE in younger individuals with malignance and bridge the gulf between guidelines and clinical practice, reported here are two young men with PE and cancer. Case 1 had a history of right femoral osteosarcoma resection and presented at the hospital with gradually worsening dyspnea and cough over a 2-week period. Although there was no abnormality at the surgical site, and no obstacle to movement, his clinical symptoms, hypoxemia, and high D-dimer level prompted our attention to the recurrence of cancer and occurrence of PE. Nuclear magnetic resonance imaging and computed tomography pulmonary angiography (CTPA) confirmed both the cancer and PE. He accepted anti-coagulant therapy immediately. Thirty days later, the patient had no obvious discomfort and received anti-tumor therapy. Case 2 presented with syncope at home without any other clinical manifestations. Similarly, hypoxemia, high D-dimer level, and a dilated and hypokinetic right ventricle upon transthoracic echocardiography strongly indicated PE, with CTPA confirming the diagnosis. Testicular cancer and a metastatic tumor were also found by ultrasonography and abdominal enhanced CT. Unfortunately, during anti-coagulation therapy, massive PE occurred and the patient died. Thus, although the incidence of cancer among young adults is lower, it is not rare. Clinicians should be alert to presentations of dyspnea, chest pain, syncope, hypoxemia, and high D-dimer level in younger individuals in order to reduce the misdiagnosis of PE.