内容紹介
An Autopsy of a Case of Pulmonary Hypertension Secondary to Pulmonary Embolization of Intrahepatic Cholangiocarcinoma
Summary
A 70-year-old woman was admitted to our hospital for one month because of progressive dyspnea. Her medical history included an operation for hepatolithiasis at age 47. She was a current smoker. Chest CT revealed emphysematous change and honeycombing in the lung and bilateral subpleural opacifications. Cardiac ultrasound examination showed pulmonary hypertension. Treatments with antibiotics, corticosteroids and heparin were unsuccessful. Despite mechanical ventilation, she died of respiratory failure. Autopsy revealed that intrahepatic cholangiocarcinoma had spread via the hematogeneous route, formed multiple emboli into the pulmonary small arteries, and led to severe pulmonary hypertension and lung infarction.
要旨
症例は70歳,女性。約1か月前より徐々に増強する呼吸困難を主訴に来院した。既往歴は47歳時胆石症の手術のみで,喫煙歴があった。CT画像上,気腫性変化と蜂巣肺に加えて両側胸膜直下に浸潤影が認められ,心臓超音波検査にて肺高血圧を認めた。抗生剤治療,ステロイド治療,抗凝固療法を行ったが奏効せず,呼吸不全が進行し人工呼吸管理となったが死亡した。剖検により肝内胆管癌が血行性に広がり,肺動脈枝内に多数の腫瘍塞栓を形成して,重篤な肺高血圧と肺梗塞を来していたことが判明した。
目次
Summary
A 70-year-old woman was admitted to our hospital for one month because of progressive dyspnea. Her medical history included an operation for hepatolithiasis at age 47. She was a current smoker. Chest CT revealed emphysematous change and honeycombing in the lung and bilateral subpleural opacifications. Cardiac ultrasound examination showed pulmonary hypertension. Treatments with antibiotics, corticosteroids and heparin were unsuccessful. Despite mechanical ventilation, she died of respiratory failure. Autopsy revealed that intrahepatic cholangiocarcinoma had spread via the hematogeneous route, formed multiple emboli into the pulmonary small arteries, and led to severe pulmonary hypertension and lung infarction.
要旨
症例は70歳,女性。約1か月前より徐々に増強する呼吸困難を主訴に来院した。既往歴は47歳時胆石症の手術のみで,喫煙歴があった。CT画像上,気腫性変化と蜂巣肺に加えて両側胸膜直下に浸潤影が認められ,心臓超音波検査にて肺高血圧を認めた。抗生剤治療,ステロイド治療,抗凝固療法を行ったが奏効せず,呼吸不全が進行し人工呼吸管理となったが死亡した。剖検により肝内胆管癌が血行性に広がり,肺動脈枝内に多数の腫瘍塞栓を形成して,重篤な肺高血圧と肺梗塞を来していたことが判明した。