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Abstract

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Article in Japanese

Case Report

A case of esophageal cancer initially presenting with bloody sputum and metastasizing to the right side of the heart causing repeated episodes of pulmonary infarction due to an arterial tumor embolism

Kenichiro Kudoa  Kiyoshi Matsuoa  Haruhiro Yamashitab  Keiichi Fujiwaraa  Toshiro Yoneia  Toshio Satoa 

aDepartment of Respiratory Medicine, Okayama Medical Center
bDepartment of Gastroenterology, Okayama Medical Center

ABSTRACT

A 65-year-old woman became aware of bloody sputum around January 2009 and visited a hospital. There she showed a nodular shadow and ground-glass opacity on chest CT and underwent a bronchoscopy. Because the bronchoalveolar lavage fluid was bloody, she was diagnosed with an idiopathic pulmonary hemorrhage. Also, a chest abnormal shadow was regressed gradually without treatment. In September of the same year, she again developed bloody sputum and exertional dyspnea, was admitted to the same hospital, and then transferred to our hospital for further evaluation. Because cardiac ultrasound showed a tumor mass attached to the tricuspid valve, it was resected, and lung biopsies were performed. Moreover, an upper gastrointestinal endoscopy revealed esophageal cancer in the middle thoracic esophagus, which suggested that the cancer had metastasized to the right side of the heart, causing pulmonary arterial tumor embolism and pulmonary infarction. These findings were accompanied by pathological evidence of pulmonary tumor thrombotic microangiopathy (PTTM). Although docetaxel chemotherapy resulted in an improvement of shadows on the CT and of the coagulation and fibrinolytic system of blood tests, the patient died about 2 months after diagnosis. The metastasis of esophageal cancer to the right side of the heart is extremely rare, and a pulmonary arterial tumor embolism was presumed to be the main cause of bloody sputum and shadows in the lung fields.

KEYWORDS

Metastatic heart tumor  Pulmonary tumor embolism  Esophageal cancer  Pulmonary infarction  Tricuspid valve replacement 

Received 24 Mar 2011 / Accepted 2 Sep 2011

AJRS, 1(1): 20-26, 2012

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