Pulmonary tumor embolism can present with acute right heart failure, according to a new case study published in the European Heart Journal Case Reports

“The diagnosis of occult cancer can be challenging, and the appropriate treatment for this entity remains an unexplored subject,” the study authors wrote.

Read more about the subtypes of CCA

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The patient was a 60-year-old female who presented to the hospital with acute pulmonary embolism and deep vein thrombosis. Her past medical history was unrevealing. 

Imaging studies confirmed pulmonary embolism. They also showed an ovarian mass and multiple hypodensities in her liver. 

The patient was hospitalized, during which time her hemodynamic state and right heart failure became worse. She eventually died of multiorgan failure. 

She underwent a post-mortem evaluation, which showed cholangiocarcinoma (CCA) cells in the pulmonary arteries.

“Pulmonary tumor embolism is a rare entity that can develop pulmonary hypertension and right heart failure,” the authors concluded. 

Pulmonary tumor embolism can be the result of many varieties of neoplasms. It can initially present as a pulmonary embolism with right heart failure and not respond to thrombolytic therapy. 

CCA is a rare type of cancer arising from the epithelium of the biliary tree. It represents around 3% of all gastrointestinal malignancies. CCA can be intrahepatic or extrahepatic. Extrahepatic CCA is further divided into 2 categories, which include perihilar or distal CCA. 

Intrahepatic CCA is the second most common type of liver cancer after hepatocellular carcinoma. Research has shown that the incidence of intrahepatic CCA has increased in the Western world in the last 30 years, with rates varying between 0.6/100,000 and 1.0/100,000 in the United States and between 0.4/100,000 and 1.8/100,000 in Europe.


Portillo-Romero A, Cuevas-Medina E, Ana-Bayona MJS, Saenz-Ancira S. Acute pulmonary tumour embolism and right systolic dysfunction in a hidden intrahepatic cholangiocarcinoma: case report. Eur Heart J Case Rep. Published online June 28, 2023. doi:10.1093/ehjcr/ytad291