A Case Report Of Pulmonary Hypertetion Associated With Lung Cancer And Literatures Review

Objective: To analyze the clinical features and diagnostic steps ofpulmonary hypertension associated with lung caner for reviewing ourexperience and improve the strategy of the diagnosis of pulmonary hypertensionassociated with lung canerMethod: Retrospectively review of a case of pulmonary hypertensionassociated with lung caner administrated in the first affiliated hospital ofGuangxi Medical University in2011, analyze its clinical manifestation,pulmonary function, radiological features and diagnostic steps, and explore itspossible mechanism with literatures review.Result:(1)General information: the Patient was female, aged40, farmer,no smoking history;(2)Clinical manifestations: the main clinicalmanifestations of this patient were cough, sputum and shortness of breath, accompaning by hemoptysis,P2>A2;(3)Laboratory examination: there wassevere hypoxemia, the CEA of the blood was mildly elevated, while CA125,CA199were significantly increased, the biochemical examination of pleuraleffusion revealed exudate fluids, and the tumor markers such as CEA,CA125,CA153and CA199of pleural fluid were significantly increased;(4)Theradiological features of the lung: the bilateral lungs showed diffuseground-glass change and multiple small nodules, the interlobular septal wasthicken,the bronchovascular bundle was thicken,the mediastinal and axillaryrevealed enlarged lymph nodes, there were bilateral pleural effusion andpericardial effusion; CT pulmonary angiography (CTPA) showed no embolicphenomenon;(5)Echocardiogram: the pulmonary artery trunk was dilated,there was severe pulmonary hypertension, the right atrium and ventricular wereslightly enlarged;(6)Pulmonary function: moderate restrictive ventilatorydysfunction, moderate diffuse dysfunction;(7)Electrocardiogram:sinustachycardia, ST-T change;(8) Cytology: there were tumor cells in the smear ofthe pleural effusion.Conclusion:(1) As we all know, the etiologies of pulmonary hypertensionare diversity, thrombotic pulmonary embolism caused by tumor cells is one ofthe etiology, however, the lung cancer itself as an etiology is rarely mentioned;(2)Pulmonary hypertension can be complicated by the lung cancer itself, so whenwe make the etiological diagnosis of the pulmonary hypertension,we shouldconsider the lung cancer routinely;(3)Its possible mechanism may be that the thickening intima of arteriolar, thrombosis or tumor thrombosis and compressedpulmonary vascular finally lead to increasing resistance of pulmonary vascular,hypoxic pulmonary vasoconstriction and remodeling of pulmonary artery;(4)Thepulmonary hypertension accociated with lung cancer can deteriorate veryrapidly, often be misdiagnosed and have a very poor prognosis.