Yadav Pramodman Singh, Dev Abinash, Shah Leeza, Khadka Ashish, Adhikari Pratik, Pyakurel Arash
Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan.
Department of Internal Medicine, Chitwan Medical College, Bharatpur.
Ann Med Surg (Lond). 2024 Aug 14;86(9):5643-5647. doi: 10.1097/MS9.0000000000002459. eCollection 2024 Sep.
Managing patients with complex comorbidities poses significant diagnostic and therapeutic challenges. This case report details a 65-year-old male with a history of decompensated chronic liver disease (CLD) and portal hypertension, who presented with symptoms suggestive of liver disease exacerbation. He was later diagnosed with primary lung malignancy and extensive thrombosis, including the inferior vena cava (IVC) and heart chambers, a rare finding.
A 65-year-old man with a history of smoking, alcohol consumption, and chronic liver disease presented with severe pain in the upper right quadrant, dyspnea, weakness, loss of appetite, and unintentional weight loss. Medical assessments revealed decompensated CLD with elevated bilirubin levels, low albumin, and an elevated INR. Imaging showed lung cancer with metastasis to the adrenal gland and a large IVC thrombus extending to the heart chambers. The patient decided to pursue palliative care.
When dealing with primary lung cancer and adrenal metastasis, it's important to thoroughly assess atypical presentations for IVC thrombus. Even with advances in imaging and treatments, managing IVC thrombus related to cancer is still difficult and requires a team approach. This case highlights underdiagnosis in areas with limited resources, emphasizing the need for timely advanced diagnostics such as CT and MR imaging.
This case highlights the complexities of diagnosing and managing patients with multiple conditions. It emphasizes the need for patient-centered care and the importance of ongoing research to develop effective diagnostic and treatment strategies for conditions like IVC thrombus in the context of malignancy.
管理患有复杂合并症的患者面临重大的诊断和治疗挑战。本病例报告详细介绍了一名65岁男性，有失代偿性慢性肝病（CLD）和门静脉高压病史，出现提示肝病加重的症状。他后来被诊断为原发性肺癌和广泛血栓形成，包括下腔静脉（IVC）和心腔，这是一个罕见的发现。
一名有吸烟、饮酒和慢性肝病病史的65岁男性，出现右上腹剧痛、呼吸困难、虚弱、食欲不振和非故意体重减轻。医学评估显示失代偿性CLD，胆红素水平升高、白蛋白降低和国际标准化比值（INR）升高。影像学检查显示肺癌伴有肾上腺转移以及一个延伸至心腔的下腔静脉大血栓。患者决定接受姑息治疗。
在处理原发性肺癌和肾上腺转移时，彻底评估下腔静脉血栓的非典型表现很重要。即使影像学和治疗方法有所进步，处理与癌症相关的下腔静脉血栓仍然困难，需要团队协作。本病例突出了资源有限地区的诊断不足，强调了及时进行CT和磁共振成像等先进诊断的必要性。
本病例突出了诊断和管理患有多种疾病患者的复杂性。它强调了以患者为中心的护理的必要性以及持续研究对于制定针对恶性肿瘤背景下下腔静脉血栓等疾病的有效诊断和治疗策略的重要性。
