Chest
POSTGRADUATE EDUCATION CORNERPULMONARY AND CRITICAL CARE PEARLSA 24-Year-Old Pregnant Patient With Diffuse Alveolar Hemorrhage
Section snippets
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.
References (0)
Cited by (5)
Alveolar hemorrhage
2015, Revue des Maladies RespiratoiresInfiltrative Lung Diseases in Pregnancy
2011, Clinics in Chest MedicineCitation 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 ReanimationMetastatic choriocarcinoma presenting in a gravid woman
2015, Gynecologic and Obstetric Investigation
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