대한흉부영상의학회 Weekly Chest Cases

Case No : 1045 Date 2017-11-06

Courtesy of Kyung Min Shin, MD. Kyung Min Shin, MD. / Kyungpook National University Medical Center
Age/Sex 23 / F
Chief ComplaintLeft chest pain

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Diagnosis With Brief Discussion

Diagnosis: Spontaneous hemothorax due to hemorrhagic metastatic choriocarcinoma
Radiologic Findings: Fig 1-5. Axial images of CT with lung window setting demonstrate multiple ill-defined nodules with halo of ground glass attenuation in the peripheral zones of both lungs. Unenhanced CT scan shows high attenuation in the pleural fluid (higher than 40 H.U) and contrast-enhanced CT image demonstrates contrast material extravasation.
A wedge resection of the left upper lobe was done. The histopathologic diagnosis was gestational trophoblastic tumor, consistent with metastatic choriocarcinoma.
Brief Review: Spontaneous hemothorax is an uncommon condition which may be related to malignancies.
The most common cause of spontaneous hemothorax is in association with pneumothorax from the rupture of vascularized adhesions or vascularized bullae. Less common causes of spontaneous hemothorax include coagulopathy, vascular rupture and neoplasm. The most common malignancies associated with spontaneous hemothorax are sarcomas, angiosarcomas, and hepatocellular carcinoma.
Trophoblastic tumors such as choriocarcinoma display three major characteristics of trophoblastic tissue: the tendency to invade blood vessels, rapid proliferation, and rich vascularity. These features account for the hemorrhagic event of metastatic choriocarcinoma such as hemoptysis and hemothorax.
Although choriocarcinoma is often preceded by molar pregnancy, some patients may present with symptoms resulting from metastases without any gynecological symptoms.
Please refer to: KSTR Imaging Conference 2005 Summer Case 10,
References: 1. Ibi et al. Choriocarcinoma of the lung: report of a case. Gen Thorac Cardiovasc Surg 2012; 60:377-380.
2. Saha K, Basuthakur S, Jash D, Bandyopadhyay A. Gestational choriocarcinoma presenting as hemothorax. Indian J Med Sci 2010;64:237-40.
Keywords: Lung, Pleura, Neoplasm, Malignant neoplasm, Metastasis,

No. of Applicants : 72

▶ Correct Answer : 14/72, 19.4%

- Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
- Seoul National University Hospital , Korea (South) JAE WON CHOI
- Other , Korea (South) SEONG SU KANG
- Kyemyung University Dongsan Hospital , Korea (South) MINJAE GU
- The Jikei university , Japan TAKU GOMI
- Gifu University Hospital , Japan Yo Kaneko
- 怨紐 , Korea (South) jin young kim
- Other , Korea (South) HAYEON LEE
- Katoh-gazou-shindan , Japan SHOICHI KATOH
- Teikyo University Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- the first affiliatited hospital of nanjing medical univercity , China HAI XU

▶ Correct Answer as Differential Diagnosis : 3/72, 4.2%

- Seoul National University Hospital , Korea (South) HAN SEUNGCHUL
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA

▶ Semi-Correct Answer : 1/72, 1.4%

- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1045 Date 2017-11-06

Discussion

No. of Applicants : 72