Pulmonary thromboembolism is a leading cause of morbidity and mortality. Many patients dying of pulmonary thromboembolism have serious underlying illness such as cancer and congestive heart failure. Cancer patients are prone to both thrombotic
and
tumor
embolism. In cancer patients, tumor pulmonary embolism and thrombotic pulmonary embolism can be associated with dyspnea, cor pulmonale and pulmonary hypertension, We presented a female patient of 63 year-old age of a hepatoma with inferior vena
cava
thrombosis. She had been transferred to the intensive care unit in state of refractory hypoxemia with 100% oxygen inhalation. Perfusion scan showed 60.71% defect in right lung and 39.28% defect in left lower lung field. Heparin infusion was done
with
the impression of pulmonary embolism without effect. Initial hemodynamic data with insertion of pulmonary artery catheter showed that cardiac index, 1.62 L/minute/M², right atrial pressure, 28 mmHg, pulmonary capillary wedge pressure 14 mmHg.
Cardiac
index did not increase in spite of dobutamine and dopamine infusion. Right atrial pressure increased to 29 mmHg but pulmonary capillary wedge pressure was 11 mmHg with fluid administration. Echocardiogram revealed that mass, 7(8 cm of size, was
in
right
heart in connection to inferior vena cave thrombus. Tumor embolism from hepatoma would be suspected in our patient, but we did not confirm that case with the biopsy or autopsy. Echocardiography with pulmoary artery catheter insertion would be
helpful to
diagnose the disease which was suspected of pulmonary embolism and tumor embolism in cancer patient. (Korean J Anesthesiol 1995; 29: 442∼446)
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