Case report on confusion: an unusual presentation of lung cancer

Abstract

Introduction: Cancer of the lung can be insidious and manifest clinically
in relatively unexpected forms. The incidence of hyponatremia in lung
cancer is 18.9% [1].
Case: An 87-year-old woman presented with confusion. She smoked
10–15 cigarettes a day for 70 years. Blood tests done; Na: 118. I made an
impression of severe symptomatic hyponatremia secondary to suspected
SiADH from possible small cell lung cancer.
I requested CXR, urine Na, paired osmolality, fluid restricted and discussed
with the medical registrar who suggested a transfer to General
hospital. CXR showed a round mass in the right upper lobe.
At the GH, Na was replaced slowly and the patient was planned for
CT scans. After 2 days, she developed gradual SOB (? PE). CT scans were
delayed because she could not lie flat and got SOB. ENT and anaesthesia
reviewed her and suggested supported airway CT under GA
Day 5 – Distended neck veins? SVCO. Anaesthetists were no longer
comfortable with GA. Unfortunately, steroids did not make her more
comfortable. DNAR in place, family informed of poor prognosis and
requested fast track discharge with palliative support. Died at home after
18 days.
Conclusion: While it is quite unusual for a respiratory condition to present
with confusion, quick recognition, open mindedness, and inter disciplinary
cooperation are essential in day-to-day practice.