弥漫性大 B 细胞淋巴瘤表现为可逆性肺内动静脉分流伴低氧血症、发热和进行性黄疸：病例报告及文献复习。
Diffuse large B-cell lymphoma presenting as reversible intrapulmonary arteriovenous shunts with hypoxia, fever and progressive jaundice: a case report and literature review.
机构信息
Department of Respiratory and Critical Care Medicine, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
Department of Infectious Diseases, Center for Liver Disease, Peking University First Hospital, Beijing, China.
出版信息
BMC Pulm Med. 2022 Mar 15;22(1):89. doi: 10.1186/s12890-022-01881-8.
BACKGROUND
Intrapulmonary arteriovenous shunts is rare seen in a patient without lung involvement.
CASE PRESENTATION
This is the first report of reversible intrapulmonary arteriovenous shunts secondary to extrapulmonary lymphoma as one initial symptom. The patient presented as fever of unknown origin and dyspnea, and examinations of infection were negative. Diagnosis of DLBCL was finally confirmed through bone marrow and splenic biopsies. Intrapulmonary arteriovenous shunts were diagnosed through 100% oxygen inhalation test and transthoracic contrast echocardiography (TTCE). After the treatment of lymphoma, his respiratory failure was relieved. We rechecked the 100% oxygen inhalation test and TTCE, which both indicated that his intrapulmonary arteriovenous shunts had resolved.
CONCLUSIONS
We speculated the prominent inflammation from active DLBCL was the most possible mechanism associated with the reversible intrapulmonary shunt in this patient. These findings will assist us to better understand the mechanism of intrapulmonary shunts.
背景
在没有肺部受累的患者中，肺内动静脉分流是罕见的。
病例介绍
这是首例以外周淋巴瘤为首发症状的可复发性肺内动静脉分流的报告。患者以不明原因发热和呼吸困难为表现，感染检查均为阴性。通过骨髓和脾活检最终确诊为弥漫性大 B 细胞淋巴瘤。通过 100%吸氧试验和经胸超声心动图（TTCE）诊断出肺内动静脉分流。在淋巴瘤治疗后，他的呼吸衰竭得到缓解。我们重新检查了 100%吸氧试验和 TTCE，结果均表明他的肺内动静脉分流已经消失。
结论
我们推测，弥漫性大 B 细胞淋巴瘤的显著炎症可能是与该患者可复发性肺内分流相关的最可能机制。这些发现将有助于我们更好地理解肺内分流的机制。
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