Koma Yasuko, Matsuoka Hirofumi, Ryoke Towa, Koyama Midori, Fukumitsu Kensuke, Kasai Yoshitaka, Masuya Daiki, Yoshimatsu Harukazu, Kitazawa Sohei, Suzuki Yujiro
Center of Respiratory Diseases, Shinko Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Aug;49(8):577-82.
We report a case of pulmonary carcinomatous lymphangitis and multiple pulmonary infarctions from gastric cancer. A 58-year-old housewife presented with a complaint of a worsening cough over the previous 6 weeks. Chest radiography and CT scans revealed infiltration and diffuse ground-glass opacities in both lung fields, and she was hospitalized for further examination. No specific findings were found upon screening examination, including bronchoscopy with bronchoalveolar lavage (BAL). However, a CT scan showed mediastinal, hilar and paraaortic lymph node swelling, and therefore we suspected the presence of a malignant tumor. On the 11th hospital day, she suddenly developed severe hypoxia and went into cardiogenic shock. Although there was no sign of a filling defect in the vessels on CT with an intravenous contrast, we diagnosed pulmonary thromboembolism based on other examination findings and began thrombolysis and anticoagulant therapy. Treatment with heparin and urokinase did not improve her condition, and she died on the 14th hospital day. The autopsy findings revealed widespread gastric cancer with pulmonary lymphangitis carcinomatosa and thrombus formation in arterioles throughout the pulmonary lobes: 'Trousseau syndrome'.
我们报告一例因胃癌导致的肺癌性淋巴管炎和多发性肺梗死病例。一名58岁的家庭主妇因在过去6周内咳嗽加重前来就诊。胸部X线和CT扫描显示双肺野浸润及弥漫性磨玻璃影，遂住院进一步检查。包括支气管镜检查及支气管肺泡灌洗（BAL）在内的筛查检查未发现特异性表现。然而，CT扫描显示纵隔、肺门及主动脉旁淋巴结肿大，因此我们怀疑存在恶性肿瘤。住院第11天，她突然出现严重缺氧并陷入心源性休克。尽管静脉注射造影剂后CT显示血管内无充盈缺损迹象，但根据其他检查结果我们诊断为肺血栓栓塞症，并开始溶栓及抗凝治疗。使用肝素和尿激酶治疗未能改善她的病情，她于住院第14天死亡。尸检结果显示广泛的胃癌伴肺淋巴管癌病以及肺小叶内小动脉血栓形成：“Trousseau综合征”。
