Case report on confusion: an unusual presentation of lung cancer

Abstract

Introduction: Cancer of the lung can be insidious and manifest clinicallyin relatively unexpected forms. The incidence of hyponatremia in lungcancer is 18.9% [1].Case: An 87-year-old woman presented with confusion. She smoked10–15 cigarettes a day for 70 years. Blood tests done; Na: 118. I made animpression of severe symptomatic hyponatremia secondary to suspectedSiADH from possible small cell lung cancer.I requested CXR, urine Na, paired osmolality, fluid restricted and discussedwith the medical registrar who suggested a transfer to Generalhospital. CXR showed a round mass in the right upper lobe.At the GH, Na was replaced slowly and the patient was planned forCT scans. After 2 days, she developed gradual SOB (? PE). CT scans weredelayed because she could not lie flat and got SOB. ENT and anaesthesiareviewed her and suggested supported airway CT under GADay 5 – Distended neck veins? SVCO. Anaesthetists were no longercomfortable with GA. Unfortunately, steroids did not make her morecomfortable. DNAR in place, family informed of poor prognosis andrequested fast track discharge with palliative support. Died at home after18 days.Conclusion: While it is quite unusual for a respiratory condition to presentwith confusion, quick recognition, open mindedness, and inter disciplinarycooperation are essential in day-to-day practice.