Key result
A 65-year-old woman with pulmonary adenocarcinoma suffered an acute ischemic stroke and anterior myocardial infarction caused by paradoxical malignant embolism from a right atrial metastasis through a patent foramen ovale.
Why the study?
Malignant arterial embolism is a rare yet often fatal cause of cardiac, cerebral, or systemic ischemia requiring immediate diagnosis and treatment.
Case Report (n=1)
This case highlights the importance of considering paradoxical malignant embolism and performing histopathological examination of emboli in cancer patients presenting with acute ischemic events.
May signal malignant embolism in cancer patients with sequential stroke-MI; leaves open whether targeted screening improves outcomes.
BACKGROUND: Embolic events play an important role in clinical everyday practice. Malignant arterial embolism is a rare nevertheless often fatal entity for cardiac, cerebral or systemic ischemia, requiring immediate diagnosis and treatment. CASE: This is a case report of a 65 years-old female, suffering from pulmonal adenocarcinoma, who was hospitalized due to neurological deficits caused by an acute ischemic stroke, followed by anterior myocardial infarction within 3 days. Diagnostic work-up revealed metastasis of the pulmonal adenocarcinoma in the right atrium and a patent foramen ovale. Histopathological examination of the coronary embolus verified paradoxical arterial embolism of the pulmonal adenocarcinoma into a coronary vessel and consequently cerebral arteries. CONCLUSION: The present case underlines the need for (i), consideration of malignant embolism, (ii) histopathological examination of the embolus to determine its etiology, and (iii) interdisciplinary discussion of individual therapeutic and prevention strategies in cancer patients with cerebral, cardiac or systemic embolic events.
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Wagner et al. (2021) conducted a case report in Paradoxical malignant embolism from cardiac metastasis (n=1). Paradoxical malignant embolism was evaluated. A 65-year-old woman with pulmonary adenocarcinoma suffered an acute ischemic stroke and anterior myocardial infarction caused by paradoxical malignant embolism from a right atrial metastasis through a patent foramen ovale.
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