ATYPICAL ELECTROMECHANICAL DISSOCIATION IN A PATIENT WITH RECURRENT PULMONARY-EMBOLISM

A 47-year-old man experienced recurrent pulmonary embolism resistant t o aggressive medical and surgical prophylaxis, Although paraneoplastic hypercoagulability was suspected, no endoscopic or radiologic signs o f malignancy were detected. Death was the result of electromechanical dissociation, which was attributed to light ventricular outflow obstru ction. At autopsy, anaplastic lung carcinoma was found in the left bas al segment with superimposed pulmonary infarction. A huge pedunculated thrombus was attached to the left ventricular apex and extended into the ascending aorta, obstructing the left ventricular outflow, To our knowledge, this is the first case of electromechanical dissociation du e to left ventricular thrombus in a patient with pulmonary embolism. R adiologic and echocardiographic evaluation of such patients should tak e into account possible masking of the underlying neoplasm by embolic or hemorrhagic phenomena, or both, and the presence of left-sided card iac thombi, which may cause catastrophic events.