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患者27岁,因停经4月余,颈部粗胀伴胸闷、心慌1月余,阴道不规则流血2天入院。查体:甲状腺Ⅱ°肿大,可闻及血管杂音,指颤阳性,心率84次/min。妇科检查:外阴有少量暗红色血液,宫颈光滑着色,宫体如5个月妊娠大。实验室检 查: HCG2000mIn/ml,β-HCG>50ng/ml,TSH1.2μIu/ml,T_3336ng/dl,T_432.3μg/dl。吸碘率曲线明显高于正常。B超示子宫增大,宫内充满薄雪状回声,并见有若干小暗区形成蜂房状,未见胎囊及胎儿。因阴道不规则流血较多,行两次吸、刮宫术,刮宫后出现咳嗽、咯血,肺部X线拍片及CT扫描发现左肺第4前肋间肺野前方有一直径约1.5cm球形致密阴影,诊为肺转移。入院诊断为恶性葡萄胎肺转移并甲亢。
27-year-old patient, due to menopause more than 4 months, neck swollen with chest tightness, palpitation more than 1 month, vaginal irregular bleeding 2 days admission. Physical examination: thyroid Ⅱ ° swollen, can be heard and vascular murmur, refers to the tremor, heart rate 84 beats / min. Gynecological examination: a small amount of dark red blood in the vulva, cervical smooth coloring, such as 5 months pregnant Palace big. Laboratory tests: HCG2000mIn / ml, β-HCG> 50ng / ml, TSH1.2μIu / ml, T_3336ng / dl, T_432.3μg / dl. Iodine absorption curve was significantly higher than normal. B ultrasound shows the uterus increases, the palace is full of thin snow-like echo, and see a number of small dark areas to form a hive-like, no fetal sac and fetal. Irregular bleeding due to vaginal irregularities, double suction, curettage, curettage, cough, hemoptysis, pulmonary X-ray and CT scan found in the left lung before the fourth intercostal lung field in front of a diameter of about 1.5cm spherical dense shadow , Diagnosed as lung metastasis. Admission was diagnosed as malignant mole pulmonary metastasis and hyperthyroidism.