Soto Soto Jose, Geiger Xochiquetzal, Johnson Margaret M
Division of Pulmonary Medicine, Mayo Clinic Florida, Jacksonville, FL 32224, USA.
Case Rep Pulmonol. 2012;2012:127583. doi: 10.1155/2012/127583. Epub 2012 Dec 18.
Pulmonary embolic disease is most commonly a manifestation of venous thromboembolism (VTE). However, fat, tumor, and air may all embolize to the pulmonary vasculature and lymphatics resulting in various clinical manifestations. Tumor emboli to small pulmonary vessels and lymphatics can lead to hypoxemic respiratory failure and shock. We present a 62-year-old male with history of mild COPD and end-stage liver disease secondary to hepatitis C admitted due to progressive shortness of breath and hypoxemia who developed shock and right ventricular failure. After a negative evaluation for venous thromboembolic disease, he had progressive respiratory and hemodynamic deterioration despite mechanical ventilation, renal replacement therapy, and vasopressive/inotropic support. Postmortem examination revealed diffuse micronodular moderately differentiated hepatocellular carcinoma (HCC) without a discrete mass, as well as numerous HCC tumor emboli to the lung and focally to the heart, consistent with disseminated hepatocellular tumor microembolism.
肺栓塞性疾病最常见是静脉血栓栓塞症（VTE）的一种表现。然而，脂肪、肿瘤和空气都可能栓塞至肺血管和淋巴管，从而导致各种临床表现。小的肺血管和淋巴管的肿瘤栓子可导致低氧性呼吸衰竭和休克。我们报告一名62岁男性，有轻度慢性阻塞性肺疾病（COPD）病史及丙型肝炎继发的终末期肝病，因进行性气短和低氧血症入院，随后出现休克和右心衰竭。在对静脉血栓栓塞症进行阴性评估后，尽管接受了机械通气、肾脏替代治疗以及血管活性/正性肌力支持，他的呼吸和血流动力学仍逐渐恶化。尸检显示弥漫性微结节性中度分化肝细胞癌（HCC），无离散肿块，还有大量HCC肿瘤栓子至肺，局部至心脏，符合播散性肝细胞肿瘤微栓塞。
