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Lung Cancer |

Diffuse Hemorrhage Alveolar Metastases: A Rare Cause of Lung Pancreatic Carcinoma

Rosa De Los Santos, MD; Sindy Cedeño de Jesus, MD; Beatriz Jimenez Rodriguez, MD; Ana Dolores Romero Ortiz, MA
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Hospital Unversitario Virgen de las Nieves, Granada, Granada, Spain


Chest. 2014;145(3_MeetingAbstracts):298A. doi:10.1378/chest.1825713
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Abstract

SESSION TITLE: Cancer Case Report Posters I

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Diffuse alveolar hemorrhage is a clinical syndrome that is generally manifested by hemoptysis, anemia, hypoxemia and alveolar infiltrates in chest X-rays.(1, 2, 3) We report the case of a patient with a very rare cause of diffuse alveolar hemorrhage: disseminated pulmonary metastases.

CASE PRESENTATION: 35 year old man with a past medical history of hypercholesterolemia, active smoker with an index of cumulative tobacco smoke exposure of one pack a day, allergic to penicillin. Epigastric pain progressing over three months studied by the Department of Digestive Diseases without findings.. She came to the Emergency Room with central chest pain radiating to both hemithoraces, with pleuritic characteristics, fever for two days and, starting one month before, cough with purulent expectoration. Three days before the patient had begun to suffer slight hemoptysis and a feeling of dyspnea. The physical examination found her general condition to be good, conscious and oriented, eupneic at rest. Cardiopulmonary auscultation normal. BP: 120/80 mmHg, heart rate: 97 bpm. The laboratory tests included mainly increased C reactive protein, with no other disorders. In the chest X-ray: Faint bilateral interstitial infiltrate. Culture of sputum produced negative results. Autoimmunity tests negative. High resolution computerized tomography (CT) scan of the abdominopelvic region revealed patchy areas of groundglass density disseminated in both lungs, alternating with alveolar consolidations and bilateral pulmonary micronodules located primarily in the bases. Solid tumor of irregular contours arising from the body of pancreas and extending back toward the celiac trunk, surrounding the splenic artery. The scan showed a large number of solid, hypodense nodular lesions disseminated throughout the hepatic parenchyma.The patient ventually leading to hypovolemic shock and death. It was decided to perform necropsy, which confirmed the diagnosis of mixed malignant pancreatic tumor.

DISCUSSION: Diffuse alveolar hemorrhage can have a very serious course if its cause is not treated. This patient presented a diffuse alveolar hemorrhage with a highly unusual etiology. (1, 2, 3)

CONCLUSIONS: Given the systemic metastatic dissemination and the sarcomatoid pathological strain of the tumor, the death of the patient could be predicted for the next 10 days.

Reference #1: Diffuse Alveolar Hemorrhage, Abigail R. Lara, MD and Marvin, I Swarz, MD. 10.1378/chest.08.2084.

Reference #2: Colby TV, Fukuoka J, Ewaskow SP, Helmers R, Leslie KO, Pathology approach to pulmonary hemorrhage. Ann diagn pathol.2001; 5(5):309-319.

Reference #3: Mayra S Aldana. Asisclo D, Saul H. hemorragia alveolar disfusa en pacientes críticos: Casos clínicos y revisión de la literatura: Med Int mexico. 2007, 23: 159-71

DISCLOSURE: The following authors have nothing to disclose: Rosa De Los Santos, Sindy Cedeño de Jesus, Beatriz Jimenez Rodriguez, Ana Dolores Romero Ortiz

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