Acute pulmonary tumour embolism and right systolic dysfunction in a hidden intrahepatic cholangiocarcinoma: case report

Figures

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  Figure 1. Angiotomography. Arrows show bilateral pulmonary embolisms in the lobar branches of the pulmonary arteries.

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  Figure 2. Abdominal computed tomography. Arrows show multiple hypodensities in the hepatic parenchyma suggestive of metastasis. A 10 cm heterogeneous mass was identified in the left adnexal region (arrowheads).

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  Figure 3. Echocardiogram. (A) Four-chamber window showing dilation of the right auricle (arrows) and dilation of the right ventricle (arrowheads). (B) Doppler ultrasound: arrow showing significant tricuspid regurgitation.

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  Figure 4. (A) Coronal cut surface of the liver: numerous nodules of different sizes are observed, yellowish white that replace the liver parenchyma in ∼85%, and these nodules are also observed on the surface where they protrude. In the centre, the cross-sectioned gallbladder contains mixed cholesterol and bile salt stones, which is why yellow and black brown colours alternate. The gallbladder wall is clear and appears not to be infiltrated. (B) Histological section of the liver: in the upper right portion of the observer is the neoplasm with a semisolid pattern with glanduloid lights. In the centre, the duct neoplasm limited by simple cuboidal epithelium with nuclear plemorphism showed an intrahepatic cholangiocarcinoma. For comparison, normal hepatocyte cords with steatosis to the observer’s left. H/E 20×.

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  Figure 5. (A) Coronal surface of the lungs, which are mostly dark brown due to intense congestion; the right upper lobe is the one that retains its spongy appearance and light brown colour. There is no evidence of infarcts or metastasis. (B) Histological section of the pulmonary artery that follows a bronchiole. Note an organizing fibrinous embolus with few cells. H/E 10×. (C) Photomicrograph at higher magnification of the tumour embolus, in which nests of malignant neoplastic cells are observed, coming from the liver. H/E 20×.