Background. Massive pulmonary thromboembolism as an initial clinical manifestation in patients with peripheral type of lung adenocarcinoma is rare. We report a case of lung cancer demonstrating pulmonary thromboembolism as the initial clinical appearance. Case. A 59-year-old man was admitted to our hospital because of edema and dyspnea. His chest radiograph revealed cardiomegaly and bilateral pleural effusion. Lung perfusion scans showed multiple defects in both lungs. A diagnosis of pulmonary thromboembolism due to deep venous thrombosis was made. He was treated with heparinization and diuretics. However, pleural effusion on the right side increased. The cytological examination revealed adenocarcinoma. Respiratory distress was progressive despite intensive care. He died due to respiratory failure two months after admission. The postmortem examination showed primary lung adenocarcinoma and massive thrombus in the pulmonary artery. Conclusion. Lung cancer preceded by coagulation disorder should be treated with caution.
SUMMARYThough acute rheumatic fever (RF) is now rare in Japan, it continues to be an important disease condition that physicians should be prepared to diagnose and treat. We describe a patient with acute RF accompanied by transient aortic regurgitation (AR). The AR was detected only by echocardiography. There were no other indications, and it disappeared after treatment with prednisolone. The changes in cardiac valves in the early phase of RF have been the subject of only a few case studies. Echocardiography is quite valuable in the workup of patients with acute RF and should be performed even if there are no signs of cardiac involvement. (Jpn Heart J 2003; 44: 291-297)
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