An Atypical Presentation of a Saddle Embolism in the Setting of Malignancy

TL;DR

A patient with renal cell carcinoma and acute appendicitis developed a massive saddle pulmonary embolism, which was successfully treated with thrombectomy.

Contribution

Highlights an unusual clinical scenario of saddle embolism in a cancer patient with dual surgical pathology.

Findings

A 52-year-old male with renal cell carcinoma and appendicitis developed a massive saddle embolism.

Thrombectomy improved oxygen saturation, and the patient was discharged on apixaban.

V/Q scan confirmed high probability of pulmonary embolism despite renal function limitations.

Abstract

A 52-year-old male presented to the emergency room with acute abdominal pain. Imaging determined acute appendicitis, with an incidental finding of a renal mass. The biopsy was positive for renal cell carcinoma, and the patient underwent simultaneous appendectomy and nephrectomy. Postoperatively, the patient developed hypoxia at night with exertion, requiring oxygen supplementation. The remainder of his vital signs were stable. Due to renal function, a ventilation/perfusion (V/Q) scan was conducted, which showed a high probability of pulmonary embolism (PE). Follow-up computed tomography angiography of the chest showed a massive saddle embolism. Interventional radiology performed an uncomplicated thrombectomy, oxygen saturations improved, and the patient was discharged on apixaban.

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