DYSPNEA IN A SMOKER IS NOT ALWAYS COPD: WHY SO BLUE?

Abstract

TYPE: Abstract Publication TOPIC: Disorders of the Mediastinum PURPOSE: Hospitalists spend less than 18% and internal medicine interns less than 12% of their time in direct patient care. 75% of the time, physicians interrupt their patient within 18 seconds of the encounter. We discuss a case where the patient was treated solely for dyspnea than having a holistic approach to all systems. METHODS: not applicabe RESULTS: 65-year-old female with history of smoking, hypertension and recent diagnosis of COPD presented with complaints of shortness of breath. She was evaluated for dyspnea when lying flat by her PCP and her symptoms were attributed to COPD exacerbation and treated with antibiotics and steroids. Two weeks later, she returned with continued dyspnea and was given albuterol prn. Following day, she presented hypoxic to the ED requiring 4L of oxygen. Lab findings suggested hyponatremia and Chest X-ray showed mediastinal fullness. CT chest was obtained showing 11.7x7.7cm mediastinal mass causing complete obstruction of SVC. Biopsy results indicated metastatic small cell lung cancer. She underwent emergent chemoradiotherapy. Patient described “blue spells on lying” which were not acknowledged during her outpatient visits. CONCLUSIONS: A recent study showed that 40% of patients present with multiple issues to their PCP. This case emphasises the art of “listening to the patient” and good physical exam which improves the diagnostic yield of the history from 19.5 to 39% and increases accuracy by another 33%. SVC syndrome should be considered in active smokers presenting with dyspnea. Approximately 2-4% of patients with lung cancer develop SVC syndrome during the course of disease. CLINICAL IMPLICATIONS: not applicable DISCLOSURE: No significant relationships. KEYWORDS: svc syndrome, lung cancer, COPD