Nguyen Thao, Chagani Fatima, Khasawneh Majd, Khasawneh Tawfiq, Jamalifard Faread
Internal Medicine, University of Florida College of Medicine, Gainesville, USA.
Pulmonology and Critical Care, University of Florida College of Medicine, Gainesville, USA.
Cureus. 2023 May 22;15(5):e39328. doi: 10.7759/cureus.39328. eCollection 2023 May.
Epithelioid hemangioendothelioma (EHE) is a very rare vascular neoplasm that is often asymptomatic. A 40-year-old woman presented to the emergency department for evaluation of a nonproductive cough, chest pain, and dyspnea. A chest computed tomography angiography (CTA) demonstrated necrotizing pneumonia, a loculated left-sided pleural effusion, and an acute pulmonary embolus. She was started on broad-spectrum intravenous antibiotics and heparin infusions, and a chest tube was placed. After minimal improvement in her pleural effusion following instillation of fibrinolytics, she underwent video-assisted thoracoscopic surgery with decortication, and a pleural biopsy was performed. Her presenting symptoms resolved shortly thereafter. Following discharge, surgical pathology resulted in a diagnosis of EHE. She was not a candidate for surgical resection and remained under surveillance. A year later, she was found to have metastatic disease, and radiotherapy was initiated. Our case, which presented as necrotizing pneumonia associated with pulmonary EHE, highlights the challenges in diagnosing this disease given its extreme rarity and discusses its management.
上皮样血管内皮瘤（EHE）是一种非常罕见的血管肿瘤，通常无症状。一名40岁女性因干咳、胸痛和呼吸困难到急诊科就诊。胸部计算机断层扫描血管造影（CTA）显示坏死性肺炎、左侧局限性胸腔积液和急性肺栓塞。她开始接受广谱静脉抗生素和肝素输注，并放置了胸管。在注入纤维蛋白溶解剂后胸腔积液改善甚微，她接受了电视辅助胸腔镜手术加胸膜剥脱术，并进行了胸膜活检。此后不久，她的症状消失。出院后，手术病理诊断为EHE。她不适合手术切除，仍在接受监测。一年后，她被发现有转移性疾病，并开始放疗。我们的病例表现为与肺部EHE相关的坏死性肺炎，鉴于其极为罕见，突出了诊断这种疾病的挑战，并讨论了其治疗方法。
