An Unusual Presentation of Simultaneous Bilateral Popliteal Artery Embolism

Abstract

We present what we believe is the first case in the literature of carcinoma of the lung presenting de novo as an intracardiac mass with bilateral, simultaneous popliteal artery embolization. Arterial thromboembolism of cardiac origin and in situ thrombosis of a preexisting atherosclerotic lesion or aneurysm account for the majority of cases of acute lower extremity ischemia. Less common causes include trauma, aortic dissection, venous ischemia, and foreign body or tissue embolization. Although the history, physical examination, and electrocardiographic findings may provide a likely explanation in many cases, noninvasive studies such as echocardiography may help further elucidate the embolic source.

Tumor Embolic Stroke: The Importance of Pathological Assessment of Clots after Thrombectomy

“…Further, the fact that lung cancer carries a high stroke risk, and that disseminated adenocarcinoma is associated with ESUS, is consistent with the hypothesis that tumor emboli may break off from pulmonary cancers and cause strokes and that tumor emboli may be an explanation for some apparent ESUS in patients with cancer [21,24]. Indeed, most tumor emboli do occur in cancers that originate in the heart or lungs or metastasize to those locations [1][2][3][4][5][6][7][8][9][10][11][12]. It is important to remember none of these findings demonstrate that tumor embolisms explain even a consequential portion of ESUS in patients with cancer, and while all of the aforementioned observations are consistent with the notion that tumor embolism may be more common than supposed, they are not specific to tumor embolism.…”

“…Tumor embolic stroke is a rare but identified phenomenon. Most existing case reports describe post-mortem identification of tumor embolic stroke, and most of these tumor emboli causing stroke or peripheral artery embolization originate in the heart, not the pulmonary vasculature [1][2][3][5][6][7][8][9][10][11][12][13]18,19].…”

“…It is also possible that pulmonary tumors rarely serve as niduses of tumor emboli; many of the described cases show tumor emboli that are sourced to the cardiac tissue from either metastasis or native cardiac cancers [1][2][3][4][5][6][7][8][9][10][11][12]. While pulmonary metastasis is very common, cardiac metastasis is not as common and cardiac cancers occur less frequently.…”

“…While tumor emboli are a rare cause of stroke, with few reported cases that are most frequently assessed post-mortem [1][2][3][4][5][6][7][8][9][10][11][12], they represent an etiology of stroke for which traditional management would be insufficient. When tumor embolic strokes occur, they are often the result of tumors that are present in or metastasize to the heart [13,14], and may affect other tissues such as the limbs [3][4][5][6][7][8][9][10][11][12][13]15,16]. Roughly half of strokes in cancer patients are embolic strokes of undetermined source (ESUS) [17].…”

Recurrent Peripheral Arterial Embolism from Metastatic Lung Choriocarcinoma

“…Tumor mass embolism is rare. 1 A review 2 on this topic was published in 2000. Recently, a patient with recurrent choriocarcinoma embolism into limb arteries was hospitalized in this department.…”