Pulmonary Thromboembolism Related to Progression of Duodenal Adenocarcinoma

十二指腸腺癌併發肺栓塞

10.6323/JoCRP.2011.27.1.6

梁逸歆(Yi-Hsin Liang)；徐志宏(Chih-Hung Hsu)

靜脈血栓栓塞 ； 肺栓塞 ； 十二指腸腺癌 ； venous thromboembolism ； pulmonary embolism ； duodenal adenocarcinoma

台灣癌症醫學雜誌

27卷1期（2011 / 02 / 01）

37 - 41

英文

靜脈血栓栓塞一般包括肺栓塞以及深靜脈血栓，是惡性腫瘤的一項主要併發症，且為不良預後因子之一。在此我們報告一位71歲男性患者，診斷為第四期十二指腸腺癌。該患者於腫瘤惡化之際併發咳血的症狀，胸部電腦斷層證實有雙側肺栓塞。經抗凝血劑以及後續的化學治療後病情轉穩。雖然十二指腸腺癌合併肺栓塞相當罕見，但臨床醫師面臨懷疑狀況時候仍然必須擁有高度警覺性，並即進行必要的診斷與治療。

Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE), is one of the major complications of cancer, and is associated with poor prognosis.Case Description: Here we present a 71-year-old man with stage IV duodenal adenocarcinoma who developed intermittent hemoptysis and had increased serum D-dimer at the time of disease progression. Chest computed tomography showed prominent filling defects within bilateral main and branch pulmonary arteries. After treatment with low-molecular weight heparin and salvage chemotherapy with gemcitabine and oxaliplatin, the patient had disease stabilization and improved PTE for the following two months.Conclusions: Although the occurrence of PTE in duodenal adenocarcinoma patients is extremely rare, a high clinical suspicion plus prompt diagnostic procedures are indicated to facilitate proper treatment of this rare condition.