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Acute Respiratory Failure Caused by Hepatopulmonary Fistula in a Patient with Hepatocellular Carcinoma

  • Lee, Jungsil (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Yoon Jun (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Hyung-Jun (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Jee-Min (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Young-Chan (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Choi, Sun Mi (Department of Internal Medicine, Seoul National University College of Medicine)
  • Received : 2015.08.27
  • Accepted : 2015.09.15
  • Published : 2016.07.01

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.

Keywords

References

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  2. Recurrent hepatogastric fistula during lenvatinib therapy for advanced hepatocellular carcinoma managed by over-the-scope clip closure: a case report vol.16, pp.2, 2016, https://doi.org/10.2185/jrm.2020-044