胃癌による微小肺塞栓で亜急性に肺高血圧を伴い呼吸困難を来し死亡した１例

Abstract

A 49-year-old woman was referred to our hospital with a complaint of subacute dyspnea with no other symptoms. Pulmonary hypertension was revealed by physical and laboratory findings. Lung scan suggested the possibility of diffuse pulmonary embolism although pulmonary arteriography showed no specific occlusion. Therapy with nitrates and heparin was started, but the effect was transient and hypoxemia was progressve. She died of hypoxemia and cardiac insufficiency despite mechanical ventilation and intensive management. A section of the lung obtained at autopsy showed a blood vessel with tumor embolus. The thrombus showed organization as well. The primary site of the tumor was the stomach. Recently, cytology obtained by pulmonary artery wedged specimen was reported to be useful for diagnosing this entity. This new type of diagnostic method should have been applied in our case. We report a case of rapidly progressive fatal pulmonary hypertension due to diffuse intravascular metastatic tumor emboli, which was difficult to diagnose prospectively. Malignant disease should be taken into consideration in the differential diagnosis of subacute pulmonary hypertension. Not only microtumor embolism but also diffuse intravascular fibrin formation due to DIC are considered to be related to the cause of pulmonary hypertension. Early diagnosis followed by prompt effective therapy for the underlying primary neoplasm might have prolonged survival.