Bergmann I, Weiss M, Schaffner T
Klinik und Poliklinik für Allgemeine Innere Medizin, Universitätsspital Bern, Schweiz.
Dtsch Med Wochenschr. 2006 Mar 24;131(12):618-21. doi: 10.1055/s-2006-933704.
A 76-year-old woman and a 62-year-old man were both referred to our clinic because of an unexplained weight loss, increasing dry cough and shortness of breath.
Investigations revealed an adenocarcinoma of the colon with retroperitoneal, mediastinal and supraclavicular lymph node metastasis and poorly differentiated carcinoma of the prostate with extensive bone metastases. During their hospital stay both patients developed increasing shortness of breath and clinical signs of right heart failure. Echocardiography confirmed severe pulmonary hypertension and dilatation of the right ventricle in both patients. Despite the high degree of clinical suspicion CT scans of the thorax could not demonstrate pulmonary embolism.
DIAGNOSIS, TREATMENT AND COURSE: During the following days the patients condition deteriorated further and both patients' died from irreversible right heart failure. Both autopsies showed extensive metastatic adenocarcinoma with marked angiosis carcinomatosa of the lungs with numerous occlusions of small arteries and arterioles and resulting cor pulmonale. Thrombotic pulmonary embolism could not be detected.
In patients with malignant neoplasms, especially adenocarcinomas, dyspnea and signs of increasing pulmonary artery pressure, the possibility of a microscopic pulmonary tumor embolism should be considered after exclusion of more usual causes especially thrombotic pulmonary embolism. In selected cases a cytologic examination of blood aspirated from a wedged pulmonary artery catheter can be performed to prove angiosis is carcinomatosa.
一名76岁女性和一名62岁男性因不明原因体重减轻、干咳加重和气促被转诊至我院。
检查发现一名患者为结肠腺癌伴腹膜后、纵隔和锁骨上淋巴结转移，另一名患者为前列腺低分化癌伴广泛骨转移。住院期间，两名患者气促均加重，并出现右心衰竭的临床体征。超声心动图证实两名患者均有严重肺动脉高压和右心室扩张。尽管临床高度怀疑，但胸部CT扫描未显示肺栓塞。
诊断、治疗及病程：在接下来的几天里，患者病情进一步恶化，均死于不可逆的右心衰竭。尸检均显示广泛转移性腺癌，肺部有明显的癌性血管生成，小动脉和小动脉有大量闭塞，导致肺心病。未检测到血栓性肺栓塞。
对于患有恶性肿瘤，尤其是腺癌，出现呼吸困难和肺动脉压升高体征的患者，在排除更常见的病因特别是血栓性肺栓塞后，应考虑微小肺肿瘤栓塞的可能性。在某些特定病例中，可对经肺动脉楔形导管抽取的血液进行细胞学检查，以证实癌性血管生成。
