PMC5153447_01
Pelvic computed tomography (CT) scan and chest radiograph on admission. (A) The CT scan showed a 62 x 40-mm cervical lesion without parametrial invasion. The tumor was mostly localized at the anterior lip of the cervix, which was enhanced heterogeneously. (B) The chest radiograph showed a marked loss of volume and diffuse ground-glass opacities, especially in the lower lung fields.
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Pelvic computed tomography (CT) revealed a heterogeneous enhancing mass (62 x 40 mm) in the cervix and the proximal part of the vagina (Fig. 1A). A chest radiography showed marked bilateral volume loss and a diffuse reticular pattern that was more predominant in the lung base than in the apex (Fig. 1B).
Changes in chest computed tomography (CT) scan findings before and 3 months after the initial treatment. (A, B) Before the treatment, the CT scan showed bilateral diffuse ground-glass opacities, reticulation opacities, and traction bronchiectasis. (C, D) Three months after the treatment, the ground-glass opacities and traction bronchiectasis had decreased dramatically.
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Chest high-resolution CT scans demonstrated widespread ground-glass opacities with reticulations and traction bronchiectasis in both lungs, suggesting ILD (Fig. 2A and B). Three months after the PMX-DHP therapy, a chest CT showed a remarkable improvement in the bilateral opacities (Fig. 2C and D), and oxygen inhalation was discontinued 3 months later, even during exercise.
The clinical course of the patient. mPSL, methylprednisolone; PSL, prednisolone; IVCY, intravenous cyclophosphamide; PMX-DHP, direct hemoperfusion using polymyxin B-immobilized fiber column; LDH, lactate dehydrogenase; P/F, PaO2/FiO2.
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PaO2/FiO2 (P/F) ratio decreased from 316.1 (PaO2 of 66.4 Torr on room air) to 147.6 (PaO2 of 73.5 Torr on venturi mask at FiO2 0.5). PMX-DHP was therefore administered at a flow rate of 100 ml/min for 4 h once daily for 2 successive days (Fig. 3).