Non-Small Cell Lung Cancer in a Pregnant Woman with Intra-cardiac Metastasis, Superior Vena Cava Syndrome and Right Main Bronchus Compression: A Case Report

肺癌往往在診斷時已經是末期且無法開刀。然而，肺癌發生心臟內轉移是很罕見的。肺癌也不常發生在懷孕的婦女身上。在此，我們要報告的案例是一位懷孕29週的33歲女性，表現的症狀是一個月以來的乾咳和逐漸變喘。胸腔超音波和胸部電腦斷層發現有巨大腫塊位在前縱隔腔合併多處肺轉移，且壓迫到氣管，和上腔靜脈，並有心臟內轉移。胸部超音波引導下切片病理結果為分化不好的肺腺癌。治療的困難點在於抉擇孕婦該何時引產，用何種方式生產，以及處理被壓迫到的呼吸道和心臟內的轉移。雖然小孩在緊急剖腹產後平安生下來，但病人不幸的在住院第十三天後死亡，死於心臟內腫瘤阻塞住心輸出血流造成的心因性休克。這個病例提醒臨床工作者應好好注意懷孕婦女所發生的無法解釋之呼吸困難，要想到有肺癌的可能性，進而安排後續檢查，如無輻射顧慮的心臟超音波和胸部超音波檢查。

關鍵字

心臟內轉移；肺癌；孕婦；上腔靜脈症候群

並列摘要

Lung cancer is often diagnosed at an advanced stage and is inoperable. However, intracardiac metastasis is rare. In addition, the occurrence of lung cancer in pregnant women is not common. Herein, we report the case of a 33-year-old female who presented at 29 weeks of gestation with a 4-week history of gradual shortness of breath and dry cough. Echocardiography and chest computed tomography showed a huge mass involving the anterior mediastinum with multiple lung metastases, compression of the trachea, carina, right main bronchus, and superior vena cava, and intracardiac metastasis. The pathology of a chest ultrasound-guided biopsy revealed non-small cell carcinoma-poorly differentiated adenocarcinoma of lung origin. The early diagnosis and treatment strategy for such a complex condition with regard to delivery method, the management of the airway and intracardiac metastasis in a pregnant woman are very difficult issues. A healthy baby boy was delivered via emergency cesarean section; however, the patient died of cardiogenic shock due to outflow obstruction by the intracardiac tumor on the 13th day of hospitalization. This case highlights the importance of clinicians being alert to cases of unusual dyspnea in pregnant women that cannot be explained by the course of the pregnancy itself.

並列關鍵字

intracardiac metastasis ； lung cancer ； pregnancy ； superior vena cava syndrome

國際替代計量

Non-Small Cell Lung Cancer in a Pregnant Woman with Intra-cardiac Metastasis, Superior Vena Cava Syndrome and Right Main Bronchus Compression: A Case Report

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