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Diagnostic delay in postpartum choriocarcinoma can precipitate severe PH, RV failure, and arrest; leaves open whether earlier detection improves outcomes in this rare disease.
BACKGROUND: Gestational trophoblastic neoplasia (choriocarcinoma) may be associated with substantial diagnostic delay because of nonspecific symptoms and the rarity of this malignancy. CASE SUMMARY: A young postpartum woman presented with progressive dyspnea, fever, and chest pain. Delayed diagnosis led to clinical deterioration with severe pulmonary hypertension (PH), right ventricular (RV) dysfunction, culminating in cardiac arrest with successful resuscitation. Ultrasound demonstrating uterine lesions and markedly elevated β-human chorionic gonadotropin (hCG) levels established the diagnosis of gestational choriocarcinoma. Cardiac magnetic resonance imaging (CMR) precisely assessed RV function and PH-related cardiac involvement. Chemotherapy normalized β-hCG levels and resolved PH and RV dysfunction. DISCUSSION: This case illustrates the diagnostic challenges of unclear dyspnea and choriocarcinoma complicated by PH and the value of CMR. TAKE-HOME MESSAGE: CMR plays an important role in the assessment of cardiopulmonary complications of choriocarcinoma, although a structured evaluation of dyspnea, including β-hCG, is essential for the early diagnosis.
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Lutay et al. (2026) studied this question.
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