Pulmonary embolism as early manifestation of malignant neoplasm of the pancreas


DOI: https://dx.doi.org/10.18565/therapy.2020.4.160-167

Tarasova L.V., Dimitrieva O.V., Busalaeva E.I., Vasilieva N.P.

1) I.N. Ulyanov Chuvashsky State University, Cheboksary; 2) Surgut State University of Khanty-Mansiysk Autonomous Okrug-Ugra; 3) Republican cardiologic dispensary of the Ministry of Healthcare of Chuvash Republic, Cheboksary; 4) Institute for advanced medical studies of the Ministry of Healthcare of the Chuvash Republic, Cheboksary
Patients with malignant tumors have thrombotic complications, which are almost 20%, all venous thromboembolism in the population. It can be one of the first stroke of a latent and undetected malignant tumor, and it complicates the malignant tumor.
The article describes a clinical case of malignant neoplasm of the pancreas, which has started from pulmonary embolism. The author summaries how diagnostic search for the cause of acute pulmonary embolism led to the correct diagnosis. The optimal therapeutic approach was chosen.
Keywords: pancreatic cancer, venous thromboembolic complications, pulmonary embolism
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Literature


  1. Тареев Е.М. Нефриты. Москва: Медгиз. 1958; 578–579. [Tareev E.M. Nephritis. M.: Medgiz. 1958; 578-579 (In Russ.)].

  2. Munkhaugen J., Lydersen S., Romundstad P.R. Wideroe T.E., Vikse B.E., Hallan S. Kidney function and future risk for adverse pregnancy outcomes: a population-based study from HUNT II, Norway. Nephrology Dialysis Transplantation. 2009; 24: 3744–50. doi: 10.1093/ndt/gfp320.

  3. Hocaoglu M., Ecder S., Turgut A., Karateke A. Pregnancy in immunoglobulin M nephropathy. J. Obstet. Gynaecol. Res. 2018; 44(1): 157–60. doi: 10.1111/jog.13489.

  4. O’Shaughnessy M.M., Jobson M.A., Sims K., et al. Pregnancy outcomes in patients with glomerular disease attending a single academic center in North Carolina. Am J Nephrol. 2017; 45: 442–51. doi: 10.1159/000471894.

  5. Cabiddu G., Castellino S., Gernone G., et al. A best practice position statement on pregnancy in chronic kidney disease: the Italian Study Group on Kidney and Pregnancy. J Nephrol. 2016; 29(3): 277–303. doi: 10.1007/s40620-016-0285-6.

  6. Brown M.A., Holt J.L., Mangos G.J., et al. Microscopic hematuria in pregnancy: relevance to pregnancy outcome. Am J Kidney Dis. 2005; 45(4): 667–73.

  7. Стрюк Р.И., Бунин Ю.А., Гурьева В.М.,с соавт. Диагностика и лечение сердечно-сосудистых заболеваний при беременности 2018. Национальные рекомендации. Российский кардиологический журнал. 2018; 155(3): 91–134. [Stryuk R.I., Bunin Yu.A., Gurieva V.M. et al. Diagnosis and treatment of cardiovascular diseases during pregnancy 2018. National guidelines. Rossiyskiy cardiologicheskiy zhurnal. 2018; 3(155): 91–134 (In Russ.)]. doi: https://doi.org/10.15829/1560-4071-2018-3-91-134.

  8. Rana S., Powe C.E., Salahuddin S., et al. Angiogenic factors and the risk of adverse outcomes in women with suspected preeclampsia. Circulation. 2012; 125(7): 911–19. doi: 10.1161/CIRCULATIONAHA.111.054361.

  9. Gomez-Arriaga P.I., Herraiz I., Lopez-Jimenez E.A., et al. Uterine artery Doppler and sFlt-1/PlGF ratio: usefulness in diagnosis of pre-eclampsia. Ultrasound Obstet Gynecol. 2013; 41(5): 530–37. doi: 10.1002/uog.12400.

  10. Wide-Swensson D., Strevens H., Willner J. Antepartum percutaneous renal biopsy. Int. J. Gynaecol. Obstet. 2007; 98: 88–92.

  11. Piccoli G.B., Daidola G., Attini R., et al. Kidney biopsy in pregnancy: evidence for counselling? A systematic narrative review. International Journal of Obstetrics and Gynaecology. 2013; 412–27. doi: 10.1111/1471-0528.12111.

  12. Smith M.C., Moran P., Ward M.K., Davison J.M. Assessment of glomerular filtration rate during pregnancy using the MDRD formula. BJOG. 2008; 111: 109–12.

  13. Saxena A.R., Ananth Karumanchi S., Fan S.L., et al. Correlation of cystatin-C with glomerular filtration rate by inulin clearance in pregnancy. Hypertens Pregnancy. 2012; 31: 22–30. doi: 10.3109/10641955.2010.507845.

  14. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int.2013; 3(1): 163.

  15. Su X., Lv J., Liu Y, et al. Pregnancy and kidney outcomes in patients with IgA nephropathy: a cohort study. Am J Kidney Dis. 2017; 70(2): 262–69. doi: 10.1053/j.ajkd.2017.01.043.

  16. Li E.F., Wang W., Wang Y., Chen Q. Fetal risks and maternal renal complications in pregnancy with preexisting chronic glomerulonephritis. Med Sci Monit. 2018; 24: 1008–16.

  17. Piccoli G.B., Kooij I.A., Attini R., et al. A systematic review on materno-foetal outcomes in pregnant women with IgA nephropathy: a case of «late-maternal» preeclampsia? J. Clin. Med. 2018; 7: 212. doi: 10.3390/jcm7080212.

  18. Johnson D. CARI Guidelines. Pregnancy and early chronic kidney disease. Australia. 2012; 10.

  19. Liu Y., Ma X., Lv J., et al. Risk factors for pregnancy outcomes in patients with iga nephropathy: a matched cohort study. Am J Kidney Dis. 2014; 64(5): 730–36. doi: 10.1053/j.ajkd.2014.06.021.

  20. Limardo M., Imbasciati E., Ravani P., et al., Rene e Gravidanza Collaborative Group of the Italian Society of Nephrology. Pregnancy and progression of IgA nephropathy: results of an Italian multicenter study. Am J Kidney Dis. 2010 Sep; 56(3): 506–12. doi: 10.1053/j.ajkd.2010.03.033.

  21. Waness A., Al Sayyari A., Salih S.B., Al Shohaib S. Increased risk of hypertension, proteinuria and preeclampsia in pregnant Saudi females with IgA nephropathy. Hypertens Pregnancy. 2010; 29(4): 385–89. doi: 10.3109/10641950903242634.

  22. Oh H.J., Han S.H., Yoo D.E., et al. Reduced pre-pregnancy proteinuria is associated with improving postnatal maternal renal outcomes in IgA nephropathy women. Clin Nephrol. 2011; 76(6): 447–54.

  23. De Castro I., Easterling T.R., Bansal N., Jefferson J.A. Nephrotic syndrome in pregnancy poses risks with both maternal and fetal complications. Kidney Int. 2017; 91(6): 1464–72. doi: 10.1016/j.kint.2016.12.019.

  24. Kwiatkowski S., Kwiatkowska E., Rzepka R. et al. Development of a focal segmental glomerulosclerosis after pregnancy complicated by preeclampsia: case report and review of literature. J Matern Fetal Neonatal Med. 2016; 29(10): 1566–69. doi: 10.3109/14767058.2015.1053865.

  25. Ohashi Y., Kobayashi S., Arai T., et al. Focal segmental glomerulosclerosis secondary to juxtaglomerular cell tumor during pregnancy: a case report. Case Rep Nephrol Urol. 2014; 4(2): 88–94. doi: 10.1159/000362757.

  26. Huang Y.-M., Zhou H.-R., Zhang L., et al. Spontaneous remission of membranous glomerulonephritis with successful fetal outcome a case report and literature review. Medicine. 2016; 95: 26(e4022). doi: 10.1097/MD.0000000000004022.

  27. Uchino E., Takada D., Mogami H., et al. Membranous nephropathy associated with pregnancy: an anti-phospholipase A2 receptor antibody-positive case report. CEN Case Rep. 2018; 7(1): 101–06. doi: 10.1007/s13730-018-0304-7.

  28. Nelson D.B. Minimal change glomerulopathy in pregnancy. Nephrol Nurs J. 2003; 30: 45–50, 55–6, 122.

  29. Lo J.O., Kerns E., Rueda J., Marshall N.E. Minimal change disease in pregnancy. J Matern Fetal Neonatal Med. 2014; 27(12): 1282–84. doi: 10.3109/14767058.2013.852178.

  30. Nair D., Kidd L., Krane K. Membranoproliferative glomerulonephritis in pregnancy. Am. J. of Med. Scien. 2017; 353(4): 320–28. doi: 10.1016/j.amjms.2017.01.007.

  31. Canadian Consensus Conference on hydroxychloroquine. Canadian rheumatology association. J Rheumatol. 2000; 27(12): 2919.

  32. Costedoat-Chalumeau N., Amoura Z., Duhaut P.,et al. Safety of hydroxychloroquine in pregnant patients with connective tissue diseases: a study of one hundred thirty-three cases compared with a control group. Arthritis Rheum. 2003; 48(11): 3207.

  33. Ostensen M., Khamashta M., Lockshin M. et al. Anti-inflammatory and immunosuppressive drugs and reproduction. Arthritis Res Ther. 2006; 8(3): 209.

  34. Sau A., Clarke S., Bass J., et al. Azathioprine and breastfeeding: is it safe? BJOG. 2007; 114(4): 498-501. doi: 10.1111/j.1471-0528.2006.01232.x.

  35. Di Paolo S., Monno R., Stallone G., et al. Placental imbalance of vasoactive factors does not affect pregnancy outcome in patients treated with Cyclosporine A after transplantation. Am J Kidney Dis. 2002; 39(4): 776.

  36. Park-Wyllie L., Mazzotta P., Pastuszak A., et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology. 2000; 62(6): 385.

  37. Mossey P.A., Little J., Munger R.G., et al. Cleft lip and palate. Lancet. 2009; 374(9703): 1773. doi: 10.1016/S0140-6736(09)60695-4.

  38. Hviid A., Mølgaard-Nielsen D. Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ. 2011; 183(7): 796–804. doi: 10.1503/cmaj.101063.

  39. Lockwood C.J., Radunovic N., Nastic D., et al. Corticotropin-releasing hormone and related pituitary-adrenal axis hormones in fetal and maternal blood during the second half of pregnancy. J Perinat Med. 1996; 24(3): 243.

  40. Hladunewich M.A., Vella J., August P. Pregnancy in women with nondialysis chronic kidney disease. UpToDate. May 2019. https://www.uptodate.com/contents/pregnancy-in-women-with-nondialysis-chronic-kidney-disease

  41. Beardmore K.S., Morris J.M., Gallery E.D. Excretion of antihypertensive medication into human breast milk: a systematic review. Hypertens Pregnancy. 2002; 21(1): 85.

  42. Boldt J. Use of albumin: an update. Br J Anaesth. 2010; 104: 276–84. doi: 10.1093/bja/aep393.

  43. Elwell R.J., Spencer A.P., Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema. Ann Pharmacother. 2003; 37(5): 695–700.


About the Autors

Larisa V. Tarasova, MD, head of the Department of faculty and hospital therapy of I.N. Ulyanov Chuvashsky State University, professor of the Department of internal diseases of Surgut State University of Khanty-Mansiysk Autonomous Okrug-Ugra. Address: 428015, Cheboksary, 45 Moskovsky Prospect. Tel.: +7 (346) 252-71-08 E-mail: tlarisagast18@mail.ru
Olga V. Dimitrieva, postgraduate student of faculty and hospital therapy of I.N. Ulyanov Chuvashsky State University, cardiologist of the Cardiologic Department of Republican cardiologic dispensary of the Ministry of Healthcare of Chuvash Republic. Address: 428015, Cheboksary, 45 Moskovsky Prospect. Tel.: +7 (917) 671-19-90. E-mail: salgarii@mail.ru
Elena I. Busalaeva, PhD, associate professor of the Department of therapy and family medicine of Institute for advanced medical studies of the Ministry of Healthcare of the Chuvash Republic. Address: 428032 Cheboksary, 27 Sespelya Str. Tel.: +7 (919) 651-62-91. E-mail: busa-elena@yandex.ru
Nina P. Vasilieva, PhD, associate professor of faculty and hospital therapy of I.N. Ulyanov Chuvashsky State University. Address: 428015, Cheboksary, 45 Moskovsky Prospect. E-mail: salgarii@mail.ru

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