Stern Emily, Huseini Taha, Kuok YiJin, Lake Fiona
Sir Charles Gairdner Hospital Perth Australia.
Department of Respiratory Medicine Royal Perth Hospital Perth Australia.
Respirol Case Rep. 2017 Jun 11;5(5):e00246. doi: 10.1002/rcr2.246. eCollection 2017 Sep.
This 52-year-old male ex-smoker presented with a six-month history of progressive breathlessness and weight loss. He deteriorated acutely, and was admitted with severe type 1 respiratory failure. Apart from diffuse coarse crackles on chest auscultation, physical examination was unremarkable. High-resolution computed tomography (HRCT) showed diffuse cystic changes throughout the lungs. A diagnosis of pulmonary Langerhans cell histiocytosis (PLCH) was considered. Further workup identified a coincidental pancreatic lesion of uncertain significance, which remained indeterminate on magnetic resonance imaging (MRI) and on positron emission tomography (PET). Transbronchial biopsy revealed enteric differentiated adenocarcinoma exhibiting lepidic spread, and autopsy later confirmed primary pancreatic malignancy. This case demonstrates that metastatic pancreatic malignancy can present with severe respiratory failure and masquerade as cystic lung disease.
这位52岁的男性曾吸烟，现出现进行性呼吸困难和体重减轻6个月的病史。他病情急剧恶化，因严重的1型呼吸衰竭入院。除胸部听诊有弥漫性粗湿啰音外，体格检查无异常。高分辨率计算机断层扫描（HRCT）显示双肺弥漫性囊性改变。考虑诊断为肺朗格汉斯细胞组织细胞增多症（PLCH）。进一步检查发现一个意义不明的胰腺病变，磁共振成像（MRI）和正电子发射断层扫描（PET）检查仍不能明确其性质。经支气管活检显示肠型分化腺癌呈鳞屑样播散，尸检后来证实为原发性胰腺恶性肿瘤。该病例表明，转移性胰腺恶性肿瘤可表现为严重呼吸衰竭，并伪装成囊性肺病。
