Chest
Volume 111, Issue 4, April 1997, Pages 1120-1121
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Selected Reports
Refractory Hypoxemia Due to Intrapulmonary Shunting Associated With Bronchioloalveolar Carcinoma

https://doi.org/10.1378/chest.111.4.1120Get rights and content

Bronchioloalveolar carcinoma caused severe refractory hypoxemia due to intrapulmonary shunting in a patient. Preoperative evaluation by occlusion of the pulmonary lobar artery supplying the tumor showed normalization of the arterial oxygen saturation. Resection of the involved lobe corrected the intrapulmonary shunting, and the patient required no further supplemental oxygen. However, with recurrence of the tumor over the next 6 months the patient became progressively more hypoxemic and died.

Section snippets

Case Report

A 71-year-old man was evaluated for breathlessness and bronchorrhea of 8 months' duration. He smoked a pack of cigarettes per day for 30 years. A chest roentgenogram showed a mass in the lower lobe of the left lung, and a CT scan suggested no mediastinal or contralateral spread. Bronchoscopy did not reveal any endobronchial lesions, but the transbronchial biopsy showed histologic features consistent with BAC (Fig 1). The patient was evaluated for resection of the lower lobe of the left lung.

Discussion

Bronchioloalveolar lung cancer in its localized form carries a better survival after surgical resection than other adenocarcinoma of lung. Our patient had cardiopulmonary function good enough to undergo resection of the lower lobe of the left lung. Surgery was denied at first because of hypoxemia. In this patient, hypoxemia proved to be due to right-to-left shunt. Balloon occlusion of the pulmonary artery of the lower lobe of the left lung effectively decreased the shunt and improved the

ACKNOWLEDGMENTS

The authors thank Timothy Connall, MD, and John Craig Collins, MD, at the Department of Surgery for their surgical services.

References (5)

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