Chest
Volume 138, Issue 1, July 2010, Pages 220-223
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POSTGRADUATE EDUCATION CORNER
PULMONARY AND CRITICAL CARE PEARLS
A 24-Year-Old Pregnant Patient With Diffuse Alveolar Hemorrhage

https://doi.org/10.1378/chest.09-2688Get rights and content

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Physical Examination

On physical examination, she had a heart rate of 125 beats/min; BP of 110/65 mm Hg; temperature of 36.6°C; and respiratory rate of 28 breaths/min. Oxygen saturation was 95% on ambient air. The cardiac examination was normal, and there was no jugular venous distension. Rales were heard over the bilateral lung bases. The abdomen was soft, gravid, and not tender. No skin lesions were noted.

Laboratory Findings

Biochemical data on admission showed a WBC count of 9,400 cells/mm3, a hematocrit level of 24%, and a

Discussion

Choriocarcinoma is a highly aggressive β-HCG-producing germ cell tumor characterized by the secretion of HCG and hematogenous metastasis. The reported incidence is one in 40,000 term pregnancies. Choriocarcinoma may develop after a hydatiform mole, spontaneous abortion, ectopic pregnancy, or term pregnancy. The tumor is highly vascular, and severe bleeding has been reported either spontaneously or during biopsy. The bleeding and metastatic tendency noted in choriocarcinoma is hypothesized to be

Clinical Pearls

  • 1.

    The diagnosis of pulmonary metastasis from choriocarcinoma requires a high index of suspicion and should be considered as a rare cause of DAH in pregnant patients.

  • 2.

    Nodular pulmonary lesions in a pregnant patient should raise the suspicion of choriocarcinoma, and β-HCG levels should be followed after delivery for an appropriate decline.

  • 3.

    Inspection of the placenta in postpartum patients with lung nodules could lead to an early diagnosis of choriocarcinoma, especially when a surgical lung biopsy

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Cited by (5)

  • Alveolar hemorrhage

    2015, Revue des Maladies Respiratoires
  • Infiltrative Lung Diseases in Pregnancy

    2011, Clinics in Chest Medicine
    Citation Excerpt :

    Metastatic pulmonary disease may present as infiltrative opacities and/or nodules, often asymptomatic, and with tumor embolism.130 Diffuse pulmonary involvement may result in severe alveolar hemorrhage with respiratory failure and death.125,131 However, the prognosis is usually good with chemotherapy.

  • Pulmonary alveolar hemorrhage

    2018, Medecine Intensive Reanimation
  • Metastatic choriocarcinoma presenting in a gravid woman

    2015, Gynecologic and Obstetric Investigation

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