28321073 Visualization

A 65 Age - year Age - old Age man Sex with a 45 Duration - year Duration history History of History cigarette Activity smoking Activity visited Clinical_event our hospital Nonbiological_location for the diagnosis of an abnormal Detailed_description chest Biological_structure shadow Sign_symptom on X Diagnostic_procedure - ray Diagnostic_procedure .
He did History not History have History any History remarkable History medical History history History and had not been prescribed anticoagulants Medication or antiplatelet Medication agents Medication .
A computed Diagnostic_procedure tomography Diagnostic_procedure ( CT Diagnostic_procedure ) scan revealed a huge Detailed_description mass Sign_symptom in the left Biological_structure upper Biological_structure lobe Biological_structure (maximum size: 11.0 Distance cm Distance in diameter) that subsequently expanded to the left Biological_structure hilum Biological_structure and mediastinum Biological_structure , as well as an intrapulmonary Biological_structure metastasis Sign_symptom located in the left Biological_structure lower Biological_structure lobe Biological_structure , pleural Disease_disorder effusion Disease_disorder on the left Detailed_description side Detailed_description , and multiple Detailed_description liver Biological_structure tumors Sign_symptom ranging from 0.5 Distance to Distance 4.7 Distance cm Distance in diameter (Fig.1).
Of note, some Detailed_description of the liver Biological_structure metastases Coreference were located Detailed_description subcapsularly Detailed_description , and the liver Biological_structure surface Biological_structure was irregularly Detailed_description distorted Sign_symptom .
The laboratory Diagnostic_procedure findings Diagnostic_procedure were as follows: white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure count Diagnostic_procedure 11,900/mm3 Lab_value , hemoglobin Diagnostic_procedure 14.8 Lab_value g/dL Lab_value , platelet Diagnostic_procedure count Diagnostic_procedure 214,000/mm3 Lab_value , aspartate Diagnostic_procedure transaminase Diagnostic_procedure 31 Lab_value IU/L Lab_value , alanine Diagnostic_procedure transaminase Diagnostic_procedure 19 Lab_value IU/L Lab_value , and lactate Diagnostic_procedure dehydrogenase Diagnostic_procedure ( LDH Diagnostic_procedure ) 749 Lab_value IU/L.
No coagulation Sign_symptom abnormalities Sign_symptom were found.
A subsequent histological Diagnostic_procedure examination Diagnostic_procedure of a tumor Sign_symptom specimen obtained by bronchoscopy Diagnostic_procedure confirmed the diagnosis of small Disease_disorder cell Disease_disorder carcinoma Disease_disorder .
On considering the clinical diagnosis, performance status, and age of the patient, we decided on a regimen of antitumor Detailed_description chemotherapy Medication consisting of cisplatin Medication ( 60 Dosage mg/m2 Dosage body Dosage surface Dosage area Dosage on Day Date 1 Date ) and etoposide Medication ( 100 Dosage mg/m2 Dosage body Dosage surface Dosage area Dosage on Days Date 1 Date - 3 Date ).
On a Date day Date after Date 2 Date weeks Date from the initial CT Diagnostic_procedure scan, he started his first chemotherapy Medication session.
On Day Date 3 Date after initiating chemotherapy, he complained of abdominal Biological_structure discomfort Sign_symptom , and his vital Diagnostic_procedure signs Diagnostic_procedure showed tachycardia Sign_symptom ( 120 Lab_value beats Lab_value per Lab_value minute Lab_value ) and hypotension Sign_symptom ( 85/55 Lab_value mmHg Lab_value ).
A hematological Diagnostic_procedure examination Diagnostic_procedure showed severe Severity anemia Sign_symptom ( hemoglobin Diagnostic_procedure 6.7 Lab_value g/dL Lab_value ) that had dramatically dropped Lab_value from 14.8 Lab_value g/dL Lab_value over Duration 10 Duration days Duration .
We attempted to identify the bleeding site on gastrointestinal Biological_structure endoscopy Diagnostic_procedure , to no avail, but a CT Diagnostic_procedure scan revealed the rapid Detailed_description enlargement Sign_symptom of a liver Biological_structure tumor Sign_symptom in the left Biological_structure lobe Biological_structure , which contained partial Detailed_description high Sign_symptom - density Sign_symptom areas Sign_symptom on the plain Diagnostic_procedure scan Diagnostic_procedure , and also a novel finding of ascites Sign_symptom showing higher Detailed_description density Detailed_description than Detailed_description usual Detailed_description , all suggesting a ruptured Detailed_description liver Biological_structure metastasis Sign_symptom and associated hemorrhagic Detailed_description ascites Sign_symptom (Fig.2).
A subsequent contrast Detailed_description - enhanced Detailed_description CT Diagnostic_procedure image was negative for extravasation Sign_symptom .
He underwent angiography Diagnostic_procedure for the left Biological_structure and Biological_structure right Biological_structure hepatic Biological_structure arteries Biological_structure , but we only observed obscure Detailed_description tumor Sign_symptom vessels Sign_symptom in the left Biological_structure hepatic Biological_structure lobe Biological_structure without extravasation Sign_symptom (Fig.3A).
We suspected this might be due to the hypovascularity of the metastatic tumors and inactive bleeding at the time.
Although the benefit of therapeutic embolization of the hepatic artery was uncertain based on the findings on angiography, we performed transcatheter Therapeutic_procedure arterial Therapeutic_procedure embolization Therapeutic_procedure ( TAE Therapeutic_procedure ) of the left Biological_structure main Biological_structure hepatic Biological_structure artery Biological_structure using gelform Therapeutic_procedure particles Therapeutic_procedure to prevent future re-bleeding.
Post-embolization angiography Diagnostic_procedure revealed a slowed Lab_value blood Diagnostic_procedure flow Diagnostic_procedure in the left Biological_structure hepatic Biological_structure artery Biological_structure , and the peripheral vessels were weakly visualized (Fig.3B).
After the embolization concomitant with supportive Therapeutic_procedure therapies Therapeutic_procedure , including RBC Medication transfusions Administration of 6 Dosage U Dosage in total, the clinical Diagnostic_procedure course Diagnostic_procedure of the patient stabilized Lab_value .
His blood Diagnostic_procedure pressure Diagnostic_procedure remained around 120/70 Lab_value mmHg Lab_value , tachycardia Sign_symptom disappeared, and the anemia Sign_symptom was improved after transfusion and did not progress again.
Liver Biological_structure dysfunction Sign_symptom did not appear.
A Date month Date after Date the embolization, he was in relatively Lab_value good Lab_value health Diagnostic_procedure and re-started his antitumor Detailed_description chemotherapy Medication , which he continued (first-line regimen) for six Dosage courses Dosage .
A good Lab_value partial Lab_value response Diagnostic_procedure was gained after chemotherapy Medication for both the lung Biological_structure and liver Biological_structure lesions Sign_symptom .