Acute Respiratory Failure Caused by Hepatopulmonary Fistula in a Patient with Hepatocellular Carcinoma.
10.4046/trd.2016.79.3.179
- Author:
Jungsil LEE
1
;
Yoon Jun KIM
;
Hyung Jun KIM
;
Jee Min KIM
;
Young Chan KIM
;
Sun Mi CHOI
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. sunmich81@gmail.com
- Publication Type:Case Report
- Keywords:
Respiratory Tract Fistula;
Pneumonia;
Carcinoma, Hepatocellular
- MeSH:
Angiography;
Anti-Bacterial Agents;
Carcinoma, Hepatocellular*;
Cough;
Dyspnea;
Endoscopy, Digestive System;
Fistula*;
Follow-Up Studies;
Hematemesis;
Hemorrhage;
Hepatitis B;
Hospitalization;
Humans;
Intubation;
Lung;
Middle Aged;
Pneumonia;
Respiratory Insufficiency*;
Respiratory Tract Fistula;
Specialization;
Sputum;
Suction;
Thorax;
Tomography, X-Ray Computed;
Varicose Veins
- From:Tuberculosis and Respiratory Diseases
2016;79(3):179-183
- CountryRepublic of Korea
- Language:English
-
Abstract:
A 59-year-old man presented with acute dyspnea following sudden productive cough and expectoration of a full cup of "blood-tinged" sputum. He had been diagnosed with hepatitis B virus-related hepatocellular carcinoma and had received transarterial chemoembolization 5 years ago for a 20-cm hepatic mass; he denied any history of hematemesis and the last esophagogastroduodenoscopy from a year ago showed absence of varix. Chest computed tomography (CT) with angiography showed new appearance of right basal lung consolidation but no bleeding focus. Despite the use of systemic antibiotics, the patient developed respiratory failure on day 7 of hospitalization. After intubation, a massive amount of brown sputum with anchovy-paste-like consistency was suctioned via the endotracheal tube. Bronchoscopic toileting was performed and the patient was extubated. In the ward, he continued to expectorate the brown sputum. On day 25 of hospitalization, a repeat CT scan showed simultaneous disappearance of the pneumonic consolidation and the necrotic fluid within the hepatic mass, suggesting the presence of a fistula. He has continued to receive systemic antibiotics, sorafenib, and entecavir, and follow up by respiratory and hepato-oncology specialists.
