Multiple pulmonary emboli as a primary presentation of renal cell carcinoma

Abstract

A 57-year-old housewife presented with complaints of sudden onset of chest pain and dyspnea. Computed tomography angiography revealed saddle-shaped pulmonary emboli in the main pulmonary artery and its branches. Evaluation for the cause of pulmonary embolism revealed a heterogeneously enhancing lesion arising from the anterior aspect of the lower pole of the left kidney. She had no hematuria, flank pain, or any palpable abdominal mass. She underwent a left open radical nephrectomy with inferior vena cava thrombectomy. Given that only 10% of patients present with the classic triad, it is often difficult to diagnose renal cell carcinoma in the early stages. Therefore, a high index of suspicion in patients with atypical presentations can lead to an early diagnosis.

Keywords

• computed tomography angiography
• pulmonary embolism
• renal cell carcinoma