NCC
Tumour Board Files |
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| The
case for discussion is a 45-year-old patient with metastatic
NSCLC, who presented with shortness of breath. The presenting
chest X-ray is shown in figure 1. What
are the causes of shortness of breath in this patient?
(See Table 1 to jog your memory).
A needle thoracentesis was attempted on the left
side with a small amount of fluid aspirated. There
was no change in patient’s symptoms, hence a
radiologic guided thoracentesis was done to improve
his dyspnea. What is the practical
algorithm to manage in cancer patients? (Refer
to Table 2)
Should this procedure be avoided
in some patients? What are the reasons for failure
of thoracentesis?
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| Table
1: Causes of Dyspnea in Cancer Patients |
CARDIOVASCULAR
CAUSES |
PULMONARY/AIRWAY
CAUSES |
-
Congestive heart failure
-
Cardia tamponade
-
Percardial effusion
-
Pulmonary embolism
-
Myocardial Infarct or ischemia
-
Superior vena cava syndrome
|
-
Restrictive airway disease
-
Pleural effusion or pleural mestastases
-
Pneumothorax
-
Kyphoscoliosis
-
Myasthenic syndromes
|
ALVEOLAR/INTERSTITIAL |
OBSTRUCTIVE |
-
Lymphangitic metastatic spread
-
Pulmonary parenchymal metastases
-
Drug/radiation induced fibrosis, e.g. Blemomycin,
BCNU
-
Drug induced pulmonary edema and interstitial pneumonitis
|
-
Airway obstruction due to tumour
-
Post-obstructive collapse
-
COLD(Chronic obstructive lung disease)
|
INFECTIONS |
SYSTEMIC |
-
Pneumonia
-
empyema
-
BOOP(Bronchiolitis obliterans organising pneumonia)
|
-
Severe anaemia
-
Severe metabolic acidosis
|
|
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| Table
2: Management Algorithm for Pleural Effusions in Lung Cancer |
| Causes
of failed re-expansion |
- Loculated
effusion
- Blockage
of airway by tumour or node impairing re-expansion
- Organised
effusion due to coagulation of proteins
- Trapped
lung due to pleural thickening
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Dr
Quek Swee Tian, Consultant, Diagnostic Imaging
Dr Koong Heng Nung, Consultant, Surgical Oncology
Dr Sandeep Rajan, Consultant, Medical Oncology |
