Multiple Lung Neoplasms

For the past 6 weeks, a 72-year-old woman with a history of ovarian cancer had had intensifying dyspnea. Initially, she thought her breathing problem was caused by progressive congestive heart failure.

The patient had no fever, chills, chest pain, or hemoptysis. Lung auscultation revealed bilateral basal crackles. She was hypoxic (her oxygen tension was 60 mm Hg while she breathed room air).

A chest roentgenogram and CT showed bilateral, diffuse, parenchymal nodules, and the patient's serum level of CA-125 was high. A CT-guided biopsy of a chest nodule revealed metastatic adenocarcinoma. The patient was referred for chemotherapy and subsequently lost to follow-up.

The lung is the second most common site of metastatic disease (following the liver). Symptoms vary and may include cough, wheezing, hemoptysis, chest pain, fatigue, and dyspnea. CT-guided or thoracoscopic biopsy is the usual method of establishing the diagnosis. If a patient has hemoptysis, bronchoscopy should be performed to rule out an endobronchial lesion.

If a single metastatic nodule is found, metastasectomy should be considered. Multiple lung metastases, however, are not amenable to surgical treatment. These imaging studies were sent by Drs Sonia Arunabh and Navin Verma of Flushing, NY.