Kurzidim K, Gnad M, Hartmann A, Held P, Riegger G, Elsner D
Klinik und Poliklinik für Innere Medizin II.
Dtsch Med Wochenschr. 1998 Nov 13;123(46):1372-7. doi: 10.1055/s-2007-1024190.
A 48-year-old man with advanced light-chain plasmacytoma was admitted because of severe dyspnoea and tachycardia. Physical examination revealed peripheral cyanosis and signs of right heart failure.
The partial pressure of oxygen and CO2 in arterial blood were both reduces (72 mm Hg and 33 mm Hg, respectively). Liver enzyme activities were increased, there was right heart enlargement radiologically and the ECG showed low voltage and typical signs of right heart strain. Echocardiography revealed cardiac metastases of the plasmacytoma with subtotal right ventricular outflow tract obstruction (RVOTO), without any signs of pulmonary emboli.
Palliative radiotherapy to the heart reduced the intracardiac tumor size and improved the patients' general condition. The signs of the RVOTO were markedly reduced in both the ECG and the echocardiogram. But after this initial improvement pneumonia developed, of which the patient died. Autopsy revealed radiation pneumonia with extensive fibrosis as the immediate cause of death.
In patients with advanced neoplasia cardiac metastasis should be included in the differential diagnosis of dyspnoea, tachycardia or hypotension of uncertain etiology. Echocardiography is the diagnostic tool of choice.
一名48岁晚期轻链浆细胞瘤男性因严重呼吸困难和心动过速入院。体格检查发现外周发绀及右心衰竭体征。
动脉血中氧分压和二氧化碳分压均降低（分别为72 mmHg和33 mmHg）。肝酶活性升高，放射学检查显示右心扩大，心电图显示低电压及典型的右心劳损体征。超声心动图显示浆细胞瘤心脏转移伴右心室流出道部分梗阻（RVOTO），无肺栓塞迹象。
心脏姑息性放疗使心内肿瘤缩小，患者一般状况改善。心电图和超声心动图显示RVOTO体征均明显减轻。但在这一初步改善后患者发生肺炎，最终死亡。尸检显示放射性肺炎伴广泛纤维化是直接死因。
对于晚期肿瘤患者，病因不明的呼吸困难、心动过速或低血压的鉴别诊断应包括心脏转移。超声心动图是首选诊断工具。
