食道鱗狀細胞癌壓迫呼吸道之一般胸部X光影像表現

Plain Chest X-ray Findings of an Esophageal Squamous Cell Carcinoma Compressing the Airway

食道癌的病人一般會以吞嚥困難及體重減輕為最初表徵，但變大的腫瘤若無完全阻塞周遭器官，至晚期可能沒有明顯症狀，致常未能早期診斷及治療，因此預後往往不佳。本文提出一位肝硬化併食道癌末期個案，其有幾點值得注意及學習事項，1.此癌症患者體重並未減輕，是因其尚可進食且因肝硬化併腹水，掩蓋了此重要表徵，2.食道癌壓迫氣管機率並不高，一來可能大的腫瘤早就應有其他症狀，且氣管有相對較硬的軟骨組織，本例有明顯呼吸道受壓迫徵候，但患者卻能忍受到晚期才就醫，其可由長期吸菸者之慢性肺疾病症狀所解釋而被忽略，3.本個案之一般胸部X光影像顯示縱隔腔稍擴大及其他異常徵候，4.影像擷取及傳輸系統使影像之複製取得方便，本文個案之X光影像異常處，與多偵測頭電腦斷層結果做比較及確認，有益於教與學，本文可提供臨床醫師在X光影像判讀學習的參考教材。

The earliest signs and symptoms of esophageal cancer are usually dysphagia and weight loss; however, unless the tumor is large and compresses or obstructs surrounding organs, patients often do not experience significant symptoms, even in more advanced stage of the disease. This accounts for its poor prognosis. In this paper, we present a patient with liver cirrhosis who was diagnosed with terminal esophageal cancer. This case illustrates some useful points: 1. Absence of weight loss or symptoms from other illnesses may mask important signs of esophageal cancer; 2. Although rare, esophageal cancer can produce respiratory symptoms by compressing the trachea and this symptom may be overlooked in chronic smokers with chronic lung diseases; 3. In this case, X-ray showed a widened mediastinum and abnormalities suggestive of cancer; however, these findings may be missed; 4. A picture archiving and communication system (PACS) can be a useful tool for teaching and learning. This case has educational value for clinicians who read plain chest X-ray.