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Washington University Experience | NEOPLASMS (MENINGIOMA) | Gross Pathology | 22A0 Case 22 History
Case 22 History ---- The decedent was a 60-year-old woman with past medical history of hyperlipidemia, hypertension, diabetes mellitus type 2, coronary and peripheral artery disease. During evaluation for blurred vision and anosmia in 2015, CT showed a 4.1 cm mass. During hospitalization for right lower extremity thrombectomy in 02/2017, an MRI showed a large (4.9 X 4.3 X 3.7 cm) diffusely enhancing, T1 and FLAIR isointense, T2 intermediate irregular subfrontal mass along the floor of the anterior cranial fossa, with extension into the posterior and medial ethmoid air cells. Her terminal presentation was with a three day history of nausea, vomiting, diarrhea and intermittent non-radiating abdominal pain, and with melena that had started in the morning of the day of admission. CT showed a thrombus in the left ventricle, septal infarct, and celiac artery thrombus. The patient was transferred to BJH CCU Aspirin, Coreg and atorvastatin were administered for management of her non-ST-elevating myocardial infarction. Transthoracic echocardiogram confirmed the thrombus in the left ventricle. As the patient’s mental status appeared to decline, she was taken for a stat head CT and abdominal X-ray and when the patient returned to the room she became more hypoxemic with her heart rate dropping into the 30s. The patient was reported to be in pulseless electrical activity and given oxygen, atropine, Narcan and epinephrine, with no chest compressions or intubation due to her expressed wishes earlier.
