Ovarian cancer with initial symptom of pulmonary embolism: A case report

Venous thromboembolism often occurs after major surgery and may occur as a consequence of underlying cancer. A 39-year-old woman presented to the emergency room with chief complaints of dyspnea and right chest pain. Chest computed tomography (CT) revealed pulmonary artery thromboembolism of the left lobe and a massive right pleural effusion. D-dimer level was 40.4 μg/mL. Abdomino-pelvic CT revealed a 15×12×14 cm solid and cystic mass in the pelvic cavity, suggesting ovarian cancer. A pleural biopsy found metastatic adenocarcinoma. She underwent cytoreductive surgery and pathologic findings revealed malignant mullerian mixed tumor of ovary. The hypercoagulable state in patients with ovarian cancer may occur as an initial symptom of pulmonary embolism. It is unresponsive to standard anticoagulation therapy. The hypercoagulable state in patient with ovarian cancer may be stopped by cytoreductive surgery of the malignancy.