Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Case Report

Volume 11, Number 2, February 2019, pages 145-150

Massive Hemoptysis Due to the Rupture of Thoracic Aortic Aneurysm Caused by Leukemic Cell Infiltration in a Patient With Chronic Myelomonocytic Leukemia

Figures

Figure 1.
Figure 1. Bone marrow examination revealed a hypercellular bone marrow with decreased megakaryocytes and increased monocytes. Forty percent of megakaryocytes had multiple, widely-separated nuclei and 10% of erythrocytes had megaloblastoid change.
Figure 2.
Figure 2. Chest X-ray examination revealed an invasion shadow near the mediastinum of the left upper lung field (a). Chest plain computed tomography revealed a tumorous lesion in left upper lobe, which progressed to the mediastinum and formed an infiltration shadow around it (b).
Figure 3.
Figure 3. Autopsy revealed that the cellular bone marrow was filled with homogeneous leukemia cells in the form of acute myeloid leukemia ((a) hematoxylin and eosin staining, × 100; (b) hematoxylin and eosin staining, × 400). A saccular aneurysm of 2.5 cm in diameter was found in the descending aortic arch. It was adhered to the left upper lobe and collapsed (arrow, c), forming a pseudoaneurysm on the lung side (d). In the aorta, infiltration of leukemia cells in the tunica media was observed, along with atherosclerotic changes ((e) arrow, hematoxylin and eosin staining, × 100; (f) hematoxylin and eosin staining, × 400; (g) Elastica van Gieson staining × 400). Infiltration of leukemia cells was also observed in the lungs near the ruptured area ((h) hematoxylin and eosin staining, × 100; (i) hematoxylin and eosin staining, × 400).

Tables

Table 1. Bone Marrow Examination at the Referred to Our Hospital
 
Bone marrow examination
NCC2,013 × 109/L
Mgk0.06 × 109/L
Basophilic erythroblast2.0%
Polychromatic erythroblast7.2%
Orthochromatic erythroblast1.4%
Myeloblast9.0%
Promyelocytes1.2%
Myelocytes25.6%
Metamyelocytes2.8%
Stab cells3.8%
Segmented cells0.2%
Eosinophil0.2%
Promonocytes3.4%
Monocytes27.2%
Lymphocytes2.6%

 

Table 2. Laboratory Data on Admission
 
APTT: activated partial thromboplastin; PT: prothrombin time; INR: international normalized ratio; FDP: fibrinogen degradation product; F: coagulation factor.
Complete blood cell count
White blood cell866 × 109/L
  Blast3.5%
  Myelocyte18.5%
  Metamyelocytes7.5%
  Stab cells1.5%
  Segmented cells25.0%
  Lymphocyte7.5%
  Monocyte36.5%
Hemoglobin6.7 g/dL
Platelet count19 × 109/L
Coagulation test
PT17.0 s
PT-INR1.38
APTT44.8 s
Fibrinogen533 mg/dL
FDP10.8 µg/mL
Blood chemistry/serological test
Total protein7.1 g/dL
Albumin2.6 g/dL
Aspartate transaminase67 U/L
Alanine aminotransferase39 U/L
Lactate dehydrogenase929 U/L
Alkaline phosphatase737 U/L
Gamma-glutamyl transpeptidase114 U/L
Total bilirubin0.7 mg/dL
Uric acid4.6 mg/dL
Urea nitrogen60 mg/dL
Creatinine3.00 mg/mL
Creatine phosphokinase35 U/L
C-reactive protein16.23 mg/dL
Infection-associated test
Blood culture (2 set)Negative
Sputum cultureResident bacteria of the oral cavity
Gaffky scale (3 set)0