CHEST Guidelines-A-Pregnant-Woman-With-Hemoptysis-and-Diffuse-Pulmo

A-Pregnant-Woman-With-Hemoptysis-and-Diffuse-Pulmo

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The document details a medical case involving a 22-year-old woman, who was 36 weeks pregnant and presented with a 4-day history of cough, hemoptysis, and exertional dyspnea. Initial investigations, including chest radiograph and CT scan, revealed diffuse bilateral pulmonary infiltrates and nodules. Despite negative results for infections and autoimmune diseases, the woman's elevated serum human chorionic gonadotropin (b-hCG) levels warranted further investigation. Following an emergency C-section, bronchoscopy identified diffuse alveolar hemorrhage but did not provide a definitive diagnosis. Finally, a surgical lung biopsy revealed malignant cells characteristic of choriocarcinoma with pulmonary involvement.<br /><br />The diagnosis was metastatic choriocarcinoma. This rare type of gestational trophoblastic neoplasm (GTN) is highly invasive and often follows any form of pregnancy event. In this case, it was suspected to be linked to a prior spontaneous abortion. The lungs are the most frequent site of metastasis, consistent with the patient's symptoms of hemoptysis and diffuse lung nodules. Radiographically, the cancer presented with a "cannonball" appearance, common for choriocarcinoma metastases.<br /><br />Prompt diagnosis of choriocarcinoma is crucial, as it is characterized by high b-hCG production, which can aid in confirming the diagnosis and monitoring treatment response. Treatment involves chemotherapy, and the prognosis is often favorable when detected early. The patient's risk score was high, indicating advanced disease, necessitating combination chemotherapy.<br /><br />The case highlights the importance of considering choriocarcinoma in differential diagnoses for pregnant women experiencing nodular lung disease and underscores the necessity for a thorough obstetric history to facilitate a timely and accurate diagnosis.

Keywords

choriocarcinoma

gestational trophoblastic neoplasm

pulmonary involvement

elevated b-hCG

metastatic cancer

diffuse alveolar hemorrhage

lung nodules

chemotherapy

obstetric history

pregnancy-related cancer