Atrial invasion and showering phenomenon in primary lung cancer: A case report

Justin Chin; Matthew Migliozzi; George Nguyen; Bina Kviatkovsky; Christine Lomiguen

doi:10.1016/j.rmcr.2020.101064

Atrial invasion and showering phenomenon in primary lung cancer: A case report

Respir Med Case Rep. 2020 Apr 23:30:101064. doi: 10.1016/j.rmcr.2020.101064. eCollection 2020.

Authors

Justin Chin¹, Matthew Migliozzi², George Nguyen³, Bina Kviatkovsky⁴, Christine Lomiguen⁵

Affiliations

¹ Department of Family Medicine, Lifelong Medical Care, Richmond, CA, USA.
² Department of Family Medicine, University of Massachusetts Medical School, Fitchburg, MA, USA.
³ Department of Internal Medicine, Banner University Medical Center - Phoenix, Phoenix, AZ, USA.
⁴ Department of Internal Medicine, Staten Island University Hospital, New York, NY, USA.
⁵ Department of Pathology, Lake Erie College of Osteopathic Medicine, Erie, PA, USA.

Abstract

Advanced lung cancer can have numerous extra-pulmonary complications. Due to the proximity to the heart, cardiac invasion and the subsequent seeding of the tumor into the vascular system present numerous challenges in physician team care coordination. Here we have a 55-year-old male who presented with stroke symptoms in the setting of undiagnosed advanced lung cancer complicated by direct tumor invasion into the left atria and mixed embolic showering phenomenon and thrombotic hypercoagulability. Review of both the embolic showering phenomenon and hypercoagulability will be discussed as both can result in embolic occlusion or metastatic seeding at distant sites. Fewer than ten cases of spontaneous tumor embolization resulting from lung cancer invasion of the pulmonary vein have been reported. Poor prognosis of advanced lung cancer requires delicate, yet pragmatic conversations between care teams and the patient.

Keywords: Embolus; Hypercoagulability; Lung cancer; Showering; Stroke; Thrombus.

Publication types

Case Reports