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Case Reports in Pulmonology
Volume 2012, Article ID 127583, 3 pages
http://dx.doi.org/10.1155/2012/127583
Case Report

Acute Right Ventricular Failure in a Patient with Hepatic Cirrhosis

1Division of Pulmonary Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA
2Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL 32224, USA

Received 18 October 2012; Accepted 29 November 2012

Academic Editors: M. Plataki and R. Vender

Copyright © 2012 Jose Soto Soto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Pulmonary embolic disease is most commonly a manifestation of venous thromboembolism (VTE). However, fat, tumor, and air may all embolize to the pulmonary vasculature and lymphatics resulting in various clinical manifestations. Tumor emboli to small pulmonary vessels and lymphatics can lead to hypoxemic respiratory failure and shock. We present a 62-year-old male with history of mild COPD and end-stage liver disease secondary to hepatitis C admitted due to progressive shortness of breath and hypoxemia who developed shock and right ventricular failure. After a negative evaluation for venous thromboembolic disease, he had progressive respiratory and hemodynamic deterioration despite mechanical ventilation, renal replacement therapy, and vasopressive/inotropic support. Postmortem examination revealed diffuse micronodular moderately differentiated hepatocellular carcinoma (HCC) without a discrete mass, as well as numerous HCC tumor emboli to the lung and focally to the heart, consistent with disseminated hepatocellular tumor microembolism.