van der Burg-de Graauw Nicole C H P, van Esser Joost W J
Amphia Ziekenhuis, Breda, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A227.
A 57-year-old woman without significant medical history presented. She had suffered from dyspnoea for the past 2 days and persistent spasmodic abdominal complaints for the past 2 weeks. Physical examination revealed tachypnoea, tachycardia and slight abdominal tenderness. Laboratory investigations revealed hypoxaemia and a strongly elevated D-dimer level. Thorax radiography revealed no abnormalities and no indications for pulmonary embolism were revealed by the CT. Abdominal ultrasound revealed multiple enlarged lymph nodes. Shortly after admission and despite resuscitation the patient died. Autopsy revealed massive pulmonary tumour embolism that originated from a primary lymphogenic metastasized coecum carcinoma. Pulmonary tumour embolism is characterised by tumour cells in the pulmonary vascular system, which exhibit no continuity with parenchymal metastases. Due to the less than specific findings revealed by history taking, physical examination and additional tests, the condition is rarely diagnosed ante mortem.
一名57岁无重大病史的女性前来就诊。她在过去2天中出现呼吸困难，在过去2周中持续有痉挛性腹部不适。体格检查发现呼吸急促、心动过速和轻微腹部压痛。实验室检查显示低氧血症和D - 二聚体水平大幅升高。胸部X线检查未发现异常，CT检查也未显示肺栓塞迹象。腹部超声显示多个肿大淋巴结。入院后不久，尽管进行了复苏，患者仍死亡。尸检发现大量肺肿瘤栓塞，其起源于原发性淋巴源性转移的盲肠癌。肺肿瘤栓塞的特征是肺血管系统中有肿瘤细胞，这些肿瘤细胞与实质转移灶无连续性。由于病史采集、体格检查和其他检查所显示的结果缺乏特异性，该病症很少在生前被诊断出来。
