急性心包填塞──肺癌的不典型初期表現

Acute Cardiac Tamponade-- An Unusual Manifestation of Lung Cancer

三十六歲女性以急性呼吸道症狀做為初始表現，在短時間內情況急轉直下，甚至面臨辦理病危自動出院。惡性心包膜積液較少以急性表徵呈現，如本案例以發燒、咳嗽、呼吸困難，合併肋膜積液到急診求醫。胸部X光因心臟輪廓變大，合併肋膜積水，被誤認為心臟衰竭，而使用利尿劑；甚至因呼吸困難被插管，使用陽壓呼吸器，這些都可能直接導致病情迅速惡化，不可不慎。心包填塞引發的心因性休克，經由適當的心包膜液引流，可立即改善心包填塞造成血行力行異常的病理生理變化。若誤失正確的臨床診斷，甚至不恰當的治療方式，可能導致嚴重的後果。針對任何不明原因造成的休克以及心臟輪廓變大，臨床都應該將心包填塞列入重要的鑑別診斷。

35 y/o lady presented with acute respiratory symptoms, including fever, cough and dyspnea. Under the impression of pneumonia and congestive heart failure, parenteral antibiotics and diuretics were prescribed. Her condition deteriorated, and was transferred into intensive care unit on the following day. Refractory shock developed after the use of mechanical ventilation. Bedside transthoracic echo disclosed massive pericardial effusion with pancycle RA collapse. Emergent pericardiocentesis re-established her hemodynamical profiles immediately. With high mortality and morbidity if un-recognized, the cardiac tamponade should be considered in any patient with unexplained shock and cardiomegaly.