warfarin and Sarcoma

We present a case of embolic acute mesenteric ischaemia (AMI) secondary to an underlying cardiac sarcoma, an exceedingly rare presentation only reported twice before. A 46-year-old man presented to accident and emergency department during the night with severe abdominal pain and vomiting. An urgent CT angiograph demonstrated superior mesenteric artery (SMA) occlusion with ischaemic small bowel. Joint surgical effort from vascular and general surgeons successfully recanalised the SMA and a 20 cm segment of small bowel was resected. Postoperatively, an echocardiogram demonstrated a mass within the left atrium. After cardiothoracic resection, the mass was found to be a rare undifferentiated cardiac sarcoma. Further staining on the embolus retrieved from the SMA revealed scattered spindle cells with a similar immunohistochemistry profile to that of the resected cardiac sarcoma. The patient was subsequently discharged well on lifelong warfarin.

Topics: Computed Tomography Angiography; Echocardiography; Heart Neoplasms; Humans; Male; Mesenteric Artery, Superior; Mesenteric Vascular Occlusion; Middle Aged; Sarcoma; Warfarin

A middle-aged patient presented with dyspnoea, haemoptysis and weight loss following a recent admission for pulmonary embolus, diagnosed on CT pulmonary angiogram (CTPA). The patient was anticoagulated with warfarin to a therapeutic range 2-3. There was no relevant medical history. On examination, the pulse was 105 bpm and blood pressure was 70/50 mm Hg. Oxygen saturation was 94% on air. Repeat CTPA revealed extension of the clot burden, now a saddle embolus occluding pulmonary outflow. The patient underwent emergency surgical embolectomy, and histology of the excised clot revealed the underlying cause--a malignant, high-grade sarcoma of the pulmonary vasculature. The target international normalised ratio was increased to 3-4. Postoperatively, the patient developed a large malignant pericardial effusion which required urgent percutaneous drainage. The patient eventually underwent targeted chemotherapy, which extended patient survival. The patient passed away a year later from progressive right-sided heart failure as a result of cor pulmonale.

Topics: Anticoagulants; Early Detection of Cancer; Humans; Lung Neoplasms; Male; Middle Aged; Pulmonary Embolism; Recurrence; Sarcoma; Vascular Neoplasms; Warfarin

Topics: Aged; Anticoagulants; Atrial Fibrillation; Biopsy, Fine-Needle; Diagnosis, Differential; Dyspnea; Female; Fluorodeoxyglucose F18; Humans; Hypertension; Lung Neoplasms; Multimodal Imaging; Positron-Emission Tomography; Pulmonary Artery; Pulmonary Embolism; Radiography, Thoracic; Sarcoma; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Vascular Neoplasms; Warfarin

Topics: Animals; Female; Lung Neoplasms; Mammary Neoplasms, Experimental; Mice; Neoplasm Metastasis; Prothrombin Time; Sarcoma; Time Factors; Warfarin