Pulmonary embolism secondary to renal tumor thrombus embolization: a challenging scenario
4 affiliations
- 1Urology Department, Habib Bourguiba Hospital, University of Sfax, Sfax, Tunisia
- 2Pedagogy Committee of the Faculty of Medicine of Sfax, Physical Medecine and Rehabilitation Department, Military Hospital, Sfax, Tunisia
- 3Urology Department, La RABTA Hospital, Tunis, Tunisia
- 4Radiology Department, Habib Bourguiba Hospital, Sfax, Tunisia
Abstract
Introduction Pulmonary embolism (PE) may reveal an occult malignancy or complicate the course of an existing cancer. Renal cell carcinoma (RCC) is highly thrombogenic, especially in the presence of venous extension or tumor thrombus into the renal vein or inferior vena cava. However, PE as a presenting or associated event of RCC is relatively uncommon and may mislead initial diagnostic orientation. Case presentation We report the case of a 55-year-old North African man presenting with acute dyspnea and pleuritic chest pain in whom computed tomographic pulmonary angiography confirmed segmental bilateral pulmonary emboli. Lower limb Doppler ultrasound was negative for deep venous thrombosis. Abdominal imaging subsequently revealed a large right renal mass with invasion of the renal vein, consistent with renal cell carcinoma with tumor thrombus. Anticoagulation was initiated, and a multidisciplinary discussion led to a plan for radical nephrectomy with thrombectomy. While urgent surgical management (radical nephrectomy + IVC thrombectomy) was being discussed with vascular surgery and anesthesia, the patient experienced abrupt cardiovascular collapse and died. Histological confirmation could not be obtained. The final diagnosis was: suspected clear cell RCC with Mayo III venous extension complicated by bilateral segmental pulmonary embolism. Conclusion This case illustrates that PE may be the initial manifestation of RCC. In cancer-associated thrombosis, absence of lower-limb deep vein thrombosis (DVT) should raise suspicion of an atypical source such as visceral venous tumor thrombus. Early imaging of the abdomen, particularly the renal–caval axis, can be crucial. Management requires coordination between oncology, urology, and vascular teams, balancing thrombotic and bleeding risks.
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BibTeX
@article{chaabouni2026pulmonary,
title = {{Pulmonary embolism secondary to renal tumor thrombus embolization: a challenging scenario}},
author = {Ahmed Chaabouni and Wafa Elleuch and Khouloud Ouertani and Kays Chaker and Yosra Mzid and Nouri Rebai and Yassine Nouira and Mourad Hadj Slimen},
journal = {Journal of Medical Case Reports},
year = {2026},
month = aug,
doi = {10.1186/s13256-026-06488-9},
url = {https://doi.org/10.1186/s13256-026-06488-9},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Pulmonary embolism secondary to renal tumor thrombus embolization: a challenging scenario
AU - Ahmed Chaabouni
AU - Wafa Elleuch
AU - Khouloud Ouertani
AU - Kays Chaker
AU - Yosra Mzid
AU - Nouri Rebai
AU - Yassine Nouira
AU - Mourad Hadj Slimen
PY - 2026
DA - 2026/08/01
JO - Journal of Medical Case Reports
DO - 10.1186/s13256-026-06488-9
UR - https://doi.org/10.1186/s13256-026-06488-9
AB - Introduction Pulmonary embolism (PE) may reveal an occult malignancy or complicate the course of an existing cancer. Renal cell carcinoma (RCC) is highly thrombogenic, especially in the presence of venous extension or tumor thrombus into the renal vein or inferior vena cava. However, PE as a presenting or associated event of RCC is relatively uncommon and may mislead initial diagnostic orientation. Case presentation We report the case of a 55-year-old North African man presenting with acute dyspnea and pleuritic chest pain in whom computed tomographic pulmonary angiography confirmed segmental bilateral pulmonary emboli. Lower limb Doppler ultrasound was negative for deep venous thrombosis. Abdominal imaging subsequently revealed a large right renal mass with invasion of the renal vein, consistent with renal cell carcinoma with tumor thrombus. Anticoagulation was initiated, and a multidisciplinary discussion led to a plan for radical nephrectomy with thrombectomy. While urgent surgical management (radical nephrectomy + IVC thrombectomy) was being discussed with vascular surgery and anesthesia, the patient experienced abrupt cardiovascular collapse and died. Histological confirmation could not be obtained. The final diagnosis was: suspected clear cell RCC with Mayo III venous extension complicated by bilateral segmental pulmonary embolism. Conclusion This case illustrates that PE may be the initial manifestation of RCC. In cancer-associated thrombosis, absence of lower-limb deep vein thrombosis (DVT) should raise suspicion of an atypical source such as visceral venous tumor thrombus. Early imaging of the abdomen, particularly the renal–caval axis, can be crucial. Management requires coordination between oncology, urology, and vascular teams, balancing thrombotic and bleeding risks.
SN - 1752-1947
ER -