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Korean J Pediatr 2012 July;55(7) :249-253.
Published online 2012 July 15.        doi:
A fatal case of acute pulmonary embolism caused by right ventricular masses of acute lymphoblastic lymphoma-leukemia in a 13 year old girl
Yu Mi Ko Ko (Ko YM), Soo Hyun Lee (Lee SH), June Huh (Huh J), Hong Hoe Koo (Koo HH), Ji Hyuk Yang (Yang JH)
Departments of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding Author: June Huh ,Tel: +82-2-3410-3526, Fax: +82-2-3410-0043, Email:
Copyright © 2012 by The Korean Pediatric Society
We report a case of a 13-year-old girl with acute lymphoblastic lymphoma- leukemia, who presented with a cardiac metastasis in the right ventricle, resulting in a pulmonary embolism. At the time of her leukemia diagnosis, a cardiac mass was incidentally found. The differential diagnosis for this unusual cardiac mass included cardiac tumor, metastasis, vegetation, and thrombus. Empirical treatment was initiated, including anticoagulation and antibiotics. She underwent plasmapheresis and was administered oral prednisolone for her leukemia. Five days later, she experienced sudden hemodynamic collapse and required extracorporeal membrane oxygenation insertion and emergency surgery. These interventions proved futile, and the patient died. Pathology revealed that the cardiac mass comprised an aggregation of small, round, necrotic cells consistent with leukemia. This is the first known case of acute lymphoblastic leukemia presenting as a right ventricular mass, with consequent fatal acute pulmonary embolism. A cardiac mass in a child with acute leukemia merits investigation to rule out every possible etiology, including vegetation, thrombus, and even a mass of leukemic cells, which could result in the fatal complication of pulmonary embolism.
Keywords: Leukemia | Metastasis | Pulmonary embolism | Child
1. Cheruvu B, Cheruvu P, Boyars M. An unusual case of metastasis to the left side of the heart: a case report. J Med Case Rep 2011;5:23.
2. Nanjappa MC, Shankarappa RK, Kalpana SR, Bhat P, Moorthy N. Intracardiac thrombi in acute myeloid leukemia: an echocardiographic and autopsy correlation. Echocardiography 2010;27:E4–E8.
3. Sakuma M, Fukui S, Nakamura M, Takahashi T, Kitamukai O, Yazu T, et al. Cancer and pulmonary embolism: thrombotic embolism, tumor embolism, and tumor invasion into a large vein. Circ J 2006;70:744–749.
4. Bassi D, Lentzner BJ, Mosca RS, Alobeid B. Primary cardiac precursor B lymphoblastic lymphoma in a child: a case report and review of the literature. Cardiovasc Pathol 2004;13:116–119.
5. Boné J, Claver A, Guallar I, Plaza AM. Allergic proctocolitis, food-induced enterocolitis: immune mechanisms, diagnosis and treatment. Allergol Immunopathol (Madr) 2009;37:36–42.
6. Rigamonti F, Beris P, Sanchez-Pareja A, Meyer P, Ashrafpoor G, Zaza S, et al. Atypical presentation of acute myeloid leukemia: cardiac myeloid sarcoma. Int J Hematol 2009;89:693–698.
7. Nowak-Gottl U, Kenet G, Mitchell LG. Thrombosis in childhood acute lymphoblastic leukaemia: epidemiology, aetiology, diagnosis, prevention and treatment. Best Pract Res Clin Haematol 2009;22:103–114.
8. Caruso V, Iacoviello L, Di Castelnuovo A, Storti S, Mariani G, de Gaetano G, et al. Thrombotic complications in childhood acute lymphoblastic leukemia: a meta-analysis of 17 prospective studies comprising 1752 pediatric patients. Blood 2006;108:2216–2222.
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Platelet count change by vincristine in maintenance phase of acute lymphoblastic leukemia chemotherapy  2006 February;49(2)
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