Acute breathlessness in lung cancer

Abstract

A 72-year-old woman with a World Health Organization (WHO) performance status of 1 presented in October 2013 with a left upper-lobe mass (fig. 1). She was an ex-smoker and a computed tomography (CT) scan showed a large mass at the left hilum (fig. 2) as well as a pulmonary embolus and a positron emission tomography (PET) scan staged the disease at T4N3M1b, with contralateral mediastinal lymphadenopathy and pelvic bone metastases. Biopsies from bronchcoscopy showed an adenocarcinoma and epidermal growth factor receptor (EGFR) mutation was negative. She underwent four cycles of palliative chemotherapy with good radiological and clinical response (fig. 3) and was started on warfarin. Figure 1 Initial presentation showed a left upper-lobe mass Figure 2 CT showing large mass at the left hilum Figure 3 After four cycles of chemotherapy, there was good response At follow-up in August 2014, progressive disease was noted radiologically (figs 4, 5 and 6) and palliative radiotherapy was thus considered for vertebral pain and then second-line chemotherapy. Figure 4 CT at follow-up Figure 5 CT at follow-up Figure 6 CT at follow-up Task 1 What do the computed tomography images show (figs 4, 5 and 6) ? 1. A small left effusion with an enlarging mass at the left hilum 2. A small pericardial effusion 3. Some degree of left upper-lobe collapse 4. All of the above Answer 1 4. All of the above She presented to the ambulatory care department via primary care with a high international normalisation ratio, probably due to the recent prescription of antibiotics for a presumed lower respiratory tract infection. At that point, she complained of increasing breathlessness and a chest radiograph was performed. Her oxygen saturation was …