CEN Case Reports

, Volume 5, Issue 1, pp 74–77 | Cite as

Subacute pulmonary embolism in a hemodialysis patient, successfully treated with surgical thrombectomy

  • Keisuke Yamasaki
  • Naoki Haruyama
  • Masatomo Taniguchi
  • Takahiro Nishida
  • Ryuji Tominaga
  • Takanari Kitazono
  • Kazuhiko TsuruyaEmail author
Case Report


A 53-year-old woman was admitted to our hospital with a 1-month history of gradually progressive resting dyspnea and lumbar backache. For the preceding 6 years, she had received regular hemodialysis for end-stage renal disease caused by autosomal dominant polycystic kidney disease and had taken tamoxifen for 3 years as post-operative chemotherapy for breast cancer. Before admission, the patient’s symptoms had been attributed to volume overload, based on right thoracic fluid and leg edema. However, despite volume correction by dialysis therapy, her symptoms had not improved. The patient was transferred to our hospital, where she was diagnosed with subacute pulmonary embolism (PE). Emergent pulmonary thrombectomy was performed using cardio-pulmonary bypass. The patient was discharged from our hospital on post-operative day 23. Recent reports have shown that hemodialysis patients have a relatively higher risk of PE compared with the general population. Our case had additional risk factors for PE: female sex, decreased protein C level, tamoxifen use, and autosomal dominant polycystic kidney disease. These factors may have had a synergistic effect on the onset of PE.


ADPKD Hemodialysis Pulmonary embolism Tamoxifen 


Compliance with ethical standards

Conflict of interest

Honoraria: Takanari Kitazono (Bayer Pharmaceutical Co., Bristol-Myers Squibb Co., Daiichi-Sankyo Co.), Kazuhiko Tsuruya (Chugai Pharmaceutical Co., Kyowa Hakko Kirin Co.); Takanari Kitazono (Astellas Pharma Inc., Daiichi-Sankyo Co., Eisai Co., Kyowa Hakko Kirin Co., Mitsubishi Tanabe Pharma Co., MSD K.K., Ono Pharmaceutical Co., Otsuka Pharmaceutical Co., Sanofi-Aventis Pharmaceutical Co., Takeda Pharmaceutical Co.), Kazuhiko Tsuruya (Chugai Pharmaceutical Co., Kyowa Hakko Kirin Co., Otsuka Pharmaceutical Co., Takeda Pharmaceutical Co.); Endowed department: Kazuhiko Tsuruya (Baxter).


  1. 1.
    Tveit DP, Hypolite IO, Hshieh P, Cruess D, Agodoa LY, Welch PG, Abbott KC. Chronic dialysis patients have high risk for pulmonary embolism. Am J Kidney Dis. 2002;39:1011–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Kumar G, Sakhuja A, Taneja A, Majumdar T, Patel J, Whittle J, Nanchal R. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol. 2012;7:1584–90.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mohan B, Chhabra ST, Aslam N, Wander GS, Sood NK, Verma S, Mehra AK, Sharma S. Mechanical breakdown and thrombolysis in subacute massive pulmonary embolism: a prospective trial. World J Cardiol. 2013;26:141–7.CrossRefGoogle Scholar
  4. 4.
    JCS Joint Working Group. Guidelines for the diagnosis treatment and prevention of pulmonary thromboembolism and deep vein thrombosis (JCS 2009). Circ J. 2011;75:1258–81.CrossRefGoogle Scholar
  5. 5.
    Casserly LF, Dember LM. Thrombosis in end-stage renal disease. Semin Dial. 2003;16:245–6.CrossRefPubMedGoogle Scholar
  6. 6.
    Molino D, De Lucia D, Gaspare De Santo N. Coagulation disorders in uremia. Semin Nephrol. 2006;26:46–51.CrossRefPubMedGoogle Scholar
  7. 7.
    Wattanakit K, Cushman M, Stehman-Breen C, Heckbert SR, Folsom AR. Chronic kidney disease increases risk for venous thromboembolism. J Am Soc Nephrol. 2008;19:135–40.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hernandez RK, Sorensen HT, Pedersen L, Jacobsen J, Lash TL. Tamoxifen treatment and risk of deep venous thrombosis and pulmonary embolism: a Danish population-based cohort study. Cancer. 2009;115:4442–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717.CrossRefGoogle Scholar
  10. 10.
    Bushnell CD, Goldstein LB. Risk of ischemic stroke with tamoxifen treatment for breast cancer: a meta-analysis. Neurology. 2004;63:1230–3.CrossRefPubMedGoogle Scholar
  11. 11.
    Torres VE, Rastogi S, King BF, Stanson AW, Gross JB Jr, Nogorney DM. Hepatic venous outflow obstruction in autosomal dominant polycystic kidney disease. J Am Soc Nephrol. 1994;5:1186–92.PubMedGoogle Scholar
  12. 12.
    Chauveau D, Grunfeld JP, Durand F, Belghiti J. Ascites in a polycystic patient. Nephrol Dial Transplant. 1997;12:228–30.CrossRefPubMedGoogle Scholar
  13. 13.
    O’Sullivan DA, Torres VE, Heit JA, Liggett S, King BF. Compression of the inferior vena cava by right renal cysts: an unusual cause of IVC and/or iliofemoral thrombosis with pulmonary embolism in autosomal dominant polycystic kidney disease. Clin Nephrol. 1998;49:332–4.PubMedGoogle Scholar
  14. 14.
    Jacquet A, Pallet N, Kessler M, Hourmant M, Garrigue V, Rostaing L, Kreis H, Legendre C, Mamzer-Bruneel MF. Outcomes of renal transplantation in patients with autosomal dominant polycystic kidney disease: a nationwide longitudinal study. Transpl Int. 2011;24:582–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Maruyama Y, Yamauchi S, Ogasawara H, Imura H, Ochi M, Shimizu K. Surgical experience of subacute pulmonary thromboembolism with severe pulmonary hypertension. Ann Thorac Cardiovasc Surg. 2006;12:60–2.PubMedGoogle Scholar
  16. 16.
    Sise ME, Courtwright AM, Channick RN. Pulmonary hypertension in patients with chronic and end-stage kidney disease. Kidney Int. 2013;84:682–92.CrossRefPubMedGoogle Scholar
  17. 17.
    Moser KM, Auger WR, Fedullo PF. Chronic major-vessel thromboembolic pulmonary hypertension. Circulation. 1990;81:1735–43.CrossRefPubMedGoogle Scholar
  18. 18.
    Nampoory MR, Das KC, Johny KV, Al-Hilali N, Abraham M, Easow S, Saed T, Al-Muzeirei IA, Sugathan TN, Al Mousawi M. Hypercoagulability, a serious problem in patients with ESRD on maintenance hemodialysis, and its correction after kidney transplantation. Am J Kidney Dis. 2003;42:797–805.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Nephrology 2016

Authors and Affiliations

  • Keisuke Yamasaki
    • 1
    • 4
  • Naoki Haruyama
    • 1
  • Masatomo Taniguchi
    • 1
  • Takahiro Nishida
    • 2
  • Ryuji Tominaga
    • 2
  • Takanari Kitazono
    • 1
  • Kazuhiko Tsuruya
    • 1
    • 3
    Email author
  1. 1.Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Cardiovascular Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  3. 3.Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  4. 4.Department of NephrologyYamaguchi Red Cross HospitalYamaguchiJapan

Personalised recommendations