播散性微血管肺肿瘤细胞栓塞：暴发性肺动脉高压的罕见原因。

Disseminated microvascular pulmonary tumor cell embolism: a rare cause of fulminant pulmonary hypertension.

作者信息

Steiner S, Plehn G, Reinecke P, Cohnen M, Schwartzkopff B, Hennersdorf M G, Strauer B E

机构信息

Department of Medicine, Division of Cardiology, Pneumology and Angiology, University Hospital Düsseldorf, Germany.

出版信息

Onkologie. 2004 Dec;27(6):566-8. doi: 10.1159/000081340.

DOI:10.1159/000081340

PMID:15591717

Abstract

BACKGROUND

Disseminated pulmonary tumor embolization is a rare cause of pulmonary hypertension and is often diagnosed only after the patient has died.

CASE REPORT

We report on a 41-year-old male who was admitted because of severe dyspnea and tachycardia. Contrast enhanced spiral computed tomography did neither establish pulmonary thromboembolism nor pulmonary metastasis. Right heart catheterization revealed severe pulmonary hypertension (pulmonary vascular resistance (PVR) 678 dyn x sec x cm(-5)). PVR did not respond to therapy with intravenous nitrate or inhaled iloprost in this critically ill patient. 2 days after admission, the patient died because of refractory right heart failure. Autopsy revealed microscopic pulmonary tumor embolism due to a metastasizing adenocarcinoma of the pancreas.

CONCLUSION

Disseminated tumor cell embolism should be considered as a rare differential diagnosis in patients with refractory pulmonary hypertension.

摘要

背景

弥漫性肺肿瘤栓塞是肺动脉高压的罕见病因，通常仅在患者死亡后才能确诊。

病例报告

我们报告一例41岁男性，因严重呼吸困难和心动过速入院。对比增强螺旋计算机断层扫描既未确诊肺血栓栓塞，也未发现肺转移。右心导管检查显示严重肺动脉高压（肺血管阻力（PVR）678达因×秒×厘米⁻⁵）。在该重症患者中，PVR对静脉注射硝酸盐或吸入伊洛前列素治疗无反应。入院2天后，患者因难治性右心衰竭死亡。尸检发现胰腺转移性腺癌导致的微观肺肿瘤栓塞。