C34. Concomitant Finding of Hemorrhagic Cardiac Tamponade and Venous Thromboembolism as the First Manifestation of Occult Malignancy – A Case Report

Venous thromboembolism (VTE) encompasses pulmonary embolism (PE), and deep vein thrombosis (DVT) is a common complication of cancer. Cancer manifestation in cardiac often secondary from the metastatic process, mostly in the pericardium. These concomitant findings of PE, DVT, and hemorrhagic cardiac tamponade as the first signs of cancer in a young patient is rare.

A 39-years-old man was referred to the emergency department from secondary hospital with the main complaint of dyspnea that onset abruptly two days before admission and swollen of the entire right leg since one week before. We report concomitant finding of hemorrhagic cardiac tamponade, deep vein thrombosis, and acute pulmonary embolism as initial presentations of occult malignancy. Starting anticoagulant in the hemorrhagic state and finding the primary cancer were problematic and challenging.

The challenge in management, posed by hemorrhagic versus thrombosis state in cancer, prompted us to cautiously deliver the treatment with consideration of benefit over the risk. Primary cancer is not always easy to identify. Comprehensive (re-)evaluation is mandatory.