Ventricular metastasis resulting in disseminated intravascular coagulation
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Case report
Ventricular metastasis resulting in disseminated intravascular coagulation Thomas John* and Ian D Davis Address: Ludwig Institute Oncology Unit, Austin Health, Heidelberg, Victoria 3084, Australia Email: Thomas John* - [email protected]; Ian D Davis - [email protected] * Corresponding author
Published: 24 May 2005 World Journal of Surgical Oncology 2005, 3:29 29
doi:10.1186/1477-7819-3-
Received: 01 March 2005 Accepted: 24 May 2005
This article is available from: http://www.wjso.com/content/3/1/29 © 2005 John and Davis; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Background: Disseminated Intravascular Coagulation (DIC) complicates up to 7% of malignancies, the commonest solid organ association being adenocarcinoma. Transitional Cell Carcinoma (TCC) has rarely been associated with DIC. Case presentation: A 74-year-old woman with TCC bladder and DIC was found to have a cardiac lesion suspicious for metastatic disease. The DIC improved with infusion of plasma and administration of Vitamin K, however the cardiac lesion was deemed inoperable and chemotherapy inappropriate; given the patients functional status. We postulate that direct activation of the coagulation cascade by the intraventricular metastasis probably triggered the coagulopathy in this patient. Conclusion: Cardiac metastases should be considered in cancer patients with otherwise unexplained DIC. This may influence treatment choices.
Background DIC is characterised by the widespread activation of coagulation. This in turn results in intravascular formation of fibrin and ultimately thrombotic occlusion of small to medium sized vessels [1]. The commonest causes are sepsis and trauma. Malignancy is a well recognised cause of a prothrombotic state, with DIC occurring in up to 7% of solid organ tumours[2]. It is most frequently associated with adenocarcinomas such as pancreatic, breast and prostate cancer. Transitional cell carcinoma is rarely associated with DIC, with very few reports in the literature.
Case presentation A 74 year old woman presented with a two day history of haematuria and increasing lethargy one month following palliative radiotherapy to the bladder for a T4 Grade III
urothelial carcinoma. Clinical examination revealed large ecchymoses over both upper and lower limbs as well as oral mucosal bleeding without any evidence of petechiae. The patient was apyrexial and vital signs were all within normal limits. There were no other significant findings on cardiovascular, respiratory and abdominal examination. Laboratory analysis revealed INR 2.7 (normal range: 0.9– 1.3), APTT 73 sec (25–38) D-dimer 25 µg/mL (0–0.2), fibrinogen
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