Primary Undiagnosed Adenocarcinoma of Lung Presenting as Acute Respiratory Distress Syndrome

病例報告：未診斷出的肺腺癌以急性呼吸窘迫症為臨床表現

張維洲(Wei-Chou Chang) ； 徐先和(Hsian-He Hsu) ； 許居誠(Giu-Cheng Hsu) ； 詹佳穎(Chia-Ing Jan) ； 陳震宇(Cheng-Yu Chen)

《中華放射線醫學雜誌》 29卷1期 (2004/02) Pp. 29-33

摘要

在臨床上惡性腫瘤導致成人呼吸窘迫症的例子是很少見的，而由肺腺癌造成成人呼吸窘迫的案例便是沒有被報告過。因此，我們報告一個54歲的男性病人，於住院十天內發展出成人呼吸窘迫症，並於三個禮拜內死亡。他的肺部電腦斷層顯示廣泛性非對稱性的浸潤及毛玻璃狀病兆，而肺腺癌診斷是靠開胸組織切片手術確立的。雖然臨床上肺腺癌的表現可以是非常多變，但是急遽惡化的現象卻是非常罕見。這篇文章主要是探討惡性腫瘤導致成人呼吸窘迫症的可能原因及案例，當臨床上遇到難治、無法解釋的成人呼吸窘迫症時，必須把惡性腫瘤列入鑑別診斷；一經診斷確定後，我們可以預期這類病人的預後會很差。

關鍵字

急性呼吸窘迫症 ； 組織切片 ； 肺腺癌 ； 廣泛性浸潤性肺病

並列摘要

Neoplastic pulmonary infiltration is an unusual but recognized cause of acute respiratory distress syndrome (ARDS). However, its occurrence with primary undiagnosed adenocarcinoma of lung has never been reported in previous instance. We herein report a 54-year-old patient who developed ARDS after ten days of respiratory symptoms and died within three weeks from his initial presentation. High-resolution computed tomography (CT) of his chest showed diffuse patchy infiltration and areas of ground-glass attenuation. Adenocarcinoma was diagnosed by open lung biopsy. Although the clinical manifestation of lung cancer is somewhat variable, rapid deterioration with ARDS is uncommon. The reports in which ARDS developed as a result of neo-plastic infiltration of the lungs is reviewed briefly. We also stress the fact that neoplasm should be considered as a possible etiology of unexplained ARDS.

並列關鍵字

ARDS ； Biopsy ； Lung adenocarcinoma ； Lung diffuse infiltrative disease