Lessons from a patient with cardiac arrest due to massive pulmonary embolism as the initial presentation of Wilms tumor: a case report and literature review

Abstract

BackgroundFinding an abdominal mass or hematuria is the initial step in diagnosing Wilms tumor. As the first manifestation of Wilms tumor, it is exceedingly rare for pulmonary tumor embolism to present with cardiac arrest. A case of a patient whose sudden cardiac arrest due to massive pulmonary tumor embolism of Wilms tumor was not responsive to resuscitation is presented.Case presentationThe patient was a five-year-old girl who collapsed suddenly during activity in nursery school and went into cardiac arrest in the ambulance. Unfortunately, she was not responsive to conventional resuscitation. A judicial autopsy conducted at the local police department showed the main cause of her sudden cardiac arrest was attributed to multiple pulmonary tumor embolisms of stage IV Wilms tumor.ConclusionsExcept for one reported case, treatments were not successful in all eight cardiac arrest cases with pulmonary tumor embolism of Wilms tumor. These results indicate that it is challenging not only to make an accurate diagnosis, but also to provide proper specific treatment in the cardiac arrest setting. We propose that flexible triage and prompt transfer to a tertiary hospital are necessary as an oncologic emergency to get such patients to bridging therapy combined with extracorporeal membrane oxygenation or immediate surgical intervention under cardiopulmonary bypass.

Sudden death caused by pulmonary tumor embolism in a dog

“…Regardless of their size, neoplastic and non-neoplastic emboli may cause severe clinicopathologic consequences, even leading to sudden death in humans and animals (BOIS et al, 2014;FAKUDA et al, 2019). These emboli may loge in various sites, depending on their size and on vascular anatomic features.…”

“…These emboli may loge in various sites, depending on their size and on vascular anatomic features. Some of the sites of embolus lodgement in humans and in animals include the aortic trifurcation, and the femoral, brachial, mesenteric, coronary, cerebral and pulmonary arteries (WINKLE et al, 1993;BOIS et al, 2014;FAKUDA et al, 2019;HE et al, 2021). Clinicopathologic presentations are variable according to the affected site.…”

Pulmonary tumor embolism: A retrospective study over a 30-year period

“…Among these papers, 84 papers were related to pulmonary tumor embolism ( Fig 4 ). Three papers were excluded, including two pediatric case reports [ 10 , 11 ] as our study focused on adults, and one paper without primary tumor information [ 12 ]. The same authors of the latter [ 12 ] published two additional papers which were included in this study.…”

“…Among these papers, 84 papers were related to pulmonary tumor embolism (Fig 4). Three papers were excluded, including two pediatric case reports [10,11] as our study focused on adults, and one paper without primary tumor information [12]. The same authors with 1999 and significantly increased in 2019 when compared with 2009, but there was no significant difference between 1999 and 2019.…”

Pulmonary Embolism and Wilms’ Tumor. Can It Be Any Worse? Case Report

“…According to the Saudi Cancer Registry in 2016, 25 nephroblastoma cases were reported, representing an incidence of 4% (National Health Information Center, 2019). Wilms tumor (WT) commonly presented as an asymptomatic abdominal mass; it tends to occupy the renal vein, causing thrombi in the inferior vena cava (IVC), and it can progress further, entering the right atrium (Ceelen et al, 1997;Fukuda et al, 2019). Nearly 6% of Wilms' tumors have intravascular extensions, and about 82% of these are particular to the IVC.…”