Kuraki T, Kobayashi H, Nagata N, Kawai T
Third Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Jun;35(6):641-4.
A 42-year-old man was hospitalized for evaluation of hypoxemia. Laboratory findings were consistent with diffuse intravascular coagulation, and the level of carcinoembryonic antigen in serum was high. Despite intensive treatment, the patient died due to hypoxemia 20 hours after admission. An autopsy revealed gastric cancer in the antrum with metastases due to the lymph nodes, liver, and bone marrow. No metastases were found in the lung parenchyma but the pulmonary microvasculature was occluded by tumor-cell microemboli. Pulmonary tumor embolism must be suspected in patients who present with hypoxemia but without parenchymal opacities on chest roentgenograms, even if there are no history of malignancy.
一名42岁男性因低氧血症入院评估。实验室检查结果符合弥漫性血管内凝血，血清癌胚抗原水平升高。尽管进行了积极治疗，但患者入院20小时后因低氧血症死亡。尸检显示胃窦部有胃癌，伴有淋巴结、肝脏和骨髓转移。肺实质未见转移，但肺微血管被肿瘤细胞微栓子阻塞。对于出现低氧血症但胸部X线片无实质病变的患者，即使无恶性肿瘤病史，也必须怀疑肺肿瘤栓塞。
