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A Patient With Lung Cancer Presenting With Respiratory Failure and ShockCancer Patient With Respiratory Failure and Shock

Jonathan Wiesen, MD; Dileep Raman, MD; Jacob Adams, DO; Chirag Choudhary, MD; Ajit Moghekar, MD
Author and Funding Information

From the Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH.

Correspondence to: Ajit Moghekar, MD, Cleveland Clinic, 9500 Euclid Ave, A90, Cleveland, OH 44195; mogheka@ccf.org


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(1):e1-e4. doi:10.1378/chest.13-0375
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A 62-year-old woman with a recent diagnosis of non-small cell lung cancer was admitted to the oncology service from her outpatient clinic for progressive dyspnea on exertion. Three weeks prior to admission she was found to have metastatic adenocarcinoma with endobronchial invasion of the trachea and right mainstem bronchus requiring placement of a silicone Y stent (Dumon Y stents have been manufactured by Novatech since 1994) to maintain airway patency. Laboratory evaluation on admission revealed leukocytosis (WBC count, 23,000 cells/uL; 77% neutrophils), anemia (hemoglobin level, 8.5 g/dL, down from 9.5 g/dL on her last hospital discharge), and acute kidney injury (serum creatinine level, 2.7 mg/dL). Further workup of her dyspnea revealed a right lower lung field opacity on chest radiograph, which was believed to be an alveolar consolidation or lung collapse (Fig 1A) and a ventilation/perfusion scan with a low probability of pulmonary embolism. Treatment with ceftriaxone and azithromycin was initiated for presumed community-acquired pneumonia.

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