Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer
We herein report a case with intractable pleural effusion attributed to superior vena cava (SVC) and upper extremity deep vein thrombosis in a patient with lung cancer. A 62-year-old woman presented to our hospital with shortness of breath and bilateral upper extremity edema. One year ago, she was d...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-01-01
|
| Series: | Respiratory Medicine Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213007120300824 |
| _version_ | 1817987837538074624 |
|---|---|
| author | Kosuke Tsuruno Kazunori Tobino Mitsukuni Sakabe Masanobu Okahisa Saori Nishizawa Kohei Yoshimine Yuki Ko Hiromi Ide |
| author_facet | Kosuke Tsuruno Kazunori Tobino Mitsukuni Sakabe Masanobu Okahisa Saori Nishizawa Kohei Yoshimine Yuki Ko Hiromi Ide |
| author_sort | Kosuke Tsuruno |
| collection | DOAJ |
| description | We herein report a case with intractable pleural effusion attributed to superior vena cava (SVC) and upper extremity deep vein thrombosis in a patient with lung cancer. A 62-year-old woman presented to our hospital with shortness of breath and bilateral upper extremity edema. One year ago, she was diagnosed with stage IVB lung adenocarcinoma with bilateral malignant pleural effusions. A genetic analysis of the cells from pleural effusion revealed an epidermal growth factor receptor (EGFR) point mutation at exon 21 (L858R); since then, she was treated with gefitinib. Although her lung cancer and metastatic lesions had markedly reduced and the tumor cells in the pleural effusion had disappeared, pleural effusion remained. Contrast-enhanced whole-body computed tomography (CT) revealed intravenous thrombosis extending from the SVC to the left brachiocephalic and subclavian veins, and her pleural effusion was attributed to this thrombosis. Anticoagulant therapy with intravenous heparin and oral warfarin was started, nevertheless, the thrombus remained and pleural effusion did not decrease. After the placement of a pleuroperitoneal shunt, her pleural effusion resolved and her symptoms improved. This case highlights the importance of awareness of SVC or upper extremity deep vein thrombosis as a differential diagnosis of intractable pleural effusion in lung cancer patients. |
| first_indexed | 2024-04-14T00:26:14Z |
| format | Article |
| id | doaj.art-30fa8f19b76546419948399c944c1513 |
| institution | Directory Open Access Journal |
| issn | 2213-0071 |
| language | English |
| last_indexed | 2024-04-14T00:26:14Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Respiratory Medicine Case Reports |
| spelling | doaj.art-30fa8f19b76546419948399c944c15132022-12-22T02:22:42ZengElsevierRespiratory Medicine Case Reports2213-00712020-01-0130101094Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancerKosuke Tsuruno0Kazunori Tobino1Mitsukuni Sakabe2Masanobu Okahisa3Saori Nishizawa4Kohei Yoshimine5Yuki Ko6Hiromi Ide7Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan; Corresponding author.Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan; Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, JapanDepartment of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, JapanDepartment of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, JapanDepartment of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, JapanDepartment of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, JapanDepartment of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, JapanDepartment of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, JapanWe herein report a case with intractable pleural effusion attributed to superior vena cava (SVC) and upper extremity deep vein thrombosis in a patient with lung cancer. A 62-year-old woman presented to our hospital with shortness of breath and bilateral upper extremity edema. One year ago, she was diagnosed with stage IVB lung adenocarcinoma with bilateral malignant pleural effusions. A genetic analysis of the cells from pleural effusion revealed an epidermal growth factor receptor (EGFR) point mutation at exon 21 (L858R); since then, she was treated with gefitinib. Although her lung cancer and metastatic lesions had markedly reduced and the tumor cells in the pleural effusion had disappeared, pleural effusion remained. Contrast-enhanced whole-body computed tomography (CT) revealed intravenous thrombosis extending from the SVC to the left brachiocephalic and subclavian veins, and her pleural effusion was attributed to this thrombosis. Anticoagulant therapy with intravenous heparin and oral warfarin was started, nevertheless, the thrombus remained and pleural effusion did not decrease. After the placement of a pleuroperitoneal shunt, her pleural effusion resolved and her symptoms improved. This case highlights the importance of awareness of SVC or upper extremity deep vein thrombosis as a differential diagnosis of intractable pleural effusion in lung cancer patients.http://www.sciencedirect.com/science/article/pii/S2213007120300824Pleural effusionUpper extremity deep vein thrombosisPleuroperitoneal shunt |
| spellingShingle | Kosuke Tsuruno Kazunori Tobino Mitsukuni Sakabe Masanobu Okahisa Saori Nishizawa Kohei Yoshimine Yuki Ko Hiromi Ide Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer Respiratory Medicine Case Reports Pleural effusion Upper extremity deep vein thrombosis Pleuroperitoneal shunt |
| title | Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer |
| title_full | Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer |
| title_fullStr | Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer |
| title_full_unstemmed | Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer |
| title_short | Intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer |
| title_sort | intractable pleural effusion associated with superior vena cava and upper extremity deep vein thrombosis in a patient with advanced lung cancer |
| topic | Pleural effusion Upper extremity deep vein thrombosis Pleuroperitoneal shunt |
| url | http://www.sciencedirect.com/science/article/pii/S2213007120300824 |
| work_keys_str_mv | AT kosuketsuruno intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer AT kazunoritobino intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer AT mitsukunisakabe intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer AT masanobuokahisa intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer AT saorinishizawa intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer AT koheiyoshimine intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer AT yukiko intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer AT hiromiide intractablepleuraleffusionassociatedwithsuperiorvenacavaandupperextremitydeepveinthrombosisinapatientwithadvancedlungcancer |