反覆胸痛的惡性肋膜間皮癌個案報告

A Case Report of Malignant Mesothelioma Presenting with Recurrent Chest Pain

惡性肋膜間皮癌在台灣的發生率不高，若忽略了個案的職業史及暴露史，不容易被納入胸痛的鑑別診斷。本文報告59歲男性個案，從事以石綿為隔熱材質的鍋爐製造業，將近兩年以反覆發作的胸痛求診，雖在病程初期即出現單側肋膜積液，但其積液不像多數的惡性肋膜積液持續地增加而是反覆地出現，再加上其臨床表現有許多發炎症候，也未詢問職業暴露史，因此病程中多以感染性疾病來治療，直至腫瘤快速生長時才安排組織學切片，確診時已是第三期的惡性肋膜間皮癌。本個案提醒基層醫師不能忽略職業史及暴露史，若有石綿暴露且病人出現反覆發作性的胸痛或肋膜積液，雖不是典型地持續增加，也應積極地安排進一步檢查。

 

Due to its low incidence in Taiwan, malignant pleural mesothelioma is seldom considered by physicians in their differential diagnosis of chest pain, especially when information about patients’ occupation and asbestos-exposure history are not obtained. This article presents a 59-year-old male, a former boiler worker with high asbestos exposure, who had recurrent chest pain with some infectious symptoms and signs in the past two years. In spite of the occurrence of unilateral pleural effusion in the early stage, biopsy was not performed to confirm mesothelioma until it rapidly progressed to stage III tumor. The physicians did not inquire into the patient’s asbestos exposure history, and his pleural effusion appeared to be remitting-relapsing, instead of the persistent and increasing manner typical of malignant pleural mesothelioma. Both factors led to the delay in his diagnosis. This case reminds physicians of the need to understand patients’ occupational and exposure history. Aggressive investigation need to be arranged for high asbestos exposure patients presenting with recurrent chest pain or remitting-relapsing pleural effusion.