Abstract
Systemic malignancy is a well-established driver of hypercoagulability, often manifesting as localised venous or arterial thromboembolism. While pulmonary embolism and stroke are commonly seen, a central embolic shower is an infrequent and often catastrophic presentation. This case highlights a massive embolic event in the presence of suspected pancreatic malignancy. A 75-year-old female presented with acute-onset lower limb ischaemia in the background of suspected pancreatic malignancy. A CT angiogram revealed not only peripheral arterial occlusion but also concomitant renal and splenic infarcts. Despite management with anticoagulation, the patient's condition deteriorated rapidly, leading to the patient's death. While central embolic showers are classically pathognomonic for cardiac myxomas, this case demonstrates their association with solid organ malignancies. Clinicians should maintain a high index of suspicion for malignancy in patients presenting with multiorgan infarcts, and this may serve as a marker of advanced, aggressive disease.