Department of Respiratory and Critical Care Medicine, Northern Jiangsu People's Hospital, Dalian Medical University, Clinical Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China.
BMC Pulm Med. 2020 Mar 26;20(1):75. doi: 10.1186/s12890-020-1077-2.
Malignant tumors are risk factors for a pulmonary embolism (PE), and a PE caused by a tumor is not uncommon. Primary pleural squamous cell carcinoma (PPSCC) is a rare malignancy; thus, a related PE is extremely rare.
A previously healthy 49-year-old female patient was admitted to Northern Jiangsu People's Hospital owing to chest tightness, cough, and breathing difficulty that persisted for 3 days. Following admission, a computed tomography (CT) pulmonary angiography revealed an embolism in the main pulmonary artery, upper and lower pulmonary artery branch. The patient was treated with alteplase, warfarin, and antibiotics. Over the following year, she experienced recurrent chest pain and tightness and breathing difficulty, with multiple CT pulmonary angiography revealing thrombosis in the right and left main pulmonary artery. No abnormalities were observed in surrogate markers of autoimmune diseases, tumor antigen testing, or ultrasonography; thus, the cause of recurrent PE was not identified. Subsequently, a positron emission tomography-computed tomography (PET-CT) examination revealed diffuse heterogeneous thickening of the right pleura and substantially increased glucose metabolism. A CT-guided pleural biopsy was performed, and histopathological examination of the pleura eventually revealed a diagnosis of PPSCC.
PPSCC is a rare tumor that lacks specific clinical manifestations and is difficult to detect with imaging techniques. The occurrence of PE as the primary manifesting symptom in a patient with PPSCC is extremely rare. Thus, malignant tumors should be considered in patients with no risk factors for PE and/or in those with recurrent PE. An immediate diagnosis and adequate intervention can be achieved with increased awareness of this diagnosis and subsequent related examinations.
恶性肿瘤是肺栓塞（PE）的危险因素，而由肿瘤引起的 PE 并不少见。原发性胸膜鳞状细胞癌（PPSCC）是一种罕见的恶性肿瘤；因此，相关的 PE 极为罕见。
一位既往健康的 49 岁女性患者因胸闷、咳嗽和呼吸困难持续 3 天而被收入苏北人民医院。入院后，计算机断层扫描（CT）肺动脉造影显示主肺动脉、上下肺动脉分支栓塞。患者接受了阿替普酶、华法林和抗生素治疗。在接下来的一年中，她反复出现胸痛、胸闷和呼吸困难，多次 CT 肺动脉造影显示左右主肺动脉血栓形成。自身免疫性疾病的替代标志物、肿瘤抗原检测或超声检查均未见异常；因此，未能确定复发性 PE 的原因。随后，正电子发射断层扫描-计算机断层扫描（PET-CT）检查显示右侧胸膜弥漫性不均匀增厚，葡萄糖代谢明显增加。进行了 CT 引导下胸膜活检，胸膜的组织病理学检查最终诊断为 PPSCC。
PPSCC 是一种罕见的肿瘤，缺乏特定的临床表现，影像学技术难以发现。PPSCC 患者以 PE 为首发表现的情况极为罕见。因此，对于无 PE 风险因素的患者和/或反复发生 PE 的患者，应考虑恶性肿瘤。提高对这种诊断的认识和随后的相关检查，可以实现及时诊断和充分干预。
