Acute haemorrhage into adrenal metastasis from NSCLC

Case contributed by Dr Chris O'Donnell

Presentation

Started chemotherapy for biopsy proven NSCLC in right lung apex with right adrenal metastasis. Sudden onset of right-sided pleuritic chest pain and hypotension ? PE thus CTPA ordered. Pre-chemotherapy CT performed 10 days earlier. On prophylactic subcutaneous Clexane to prevent DVT. Clinician confirmed reduced serum haemoglobin.

Patient Data

Age: 65
Gender: Male

Irregular mass in the right lung apex (arrow) is associated with a large right adrenal mass lesion with central low density indicative of necrosis (arrow).  Right lung base is clear.  Subsequent CTPA shows marked right lung atelectasis with pleural fluid with a dramatic increase in size of the metastasis with central high denisty indicative of haemorrhage (arrow).  This explains the right sided pleuritic symptoms and hypotension.  No signs of PE.

Case Discussion

Spontaneous haemorhage into adrenal metastasis is rare and usually associated with melanoma.  Lung cancer metastasis to adrenals is common but haemorrhage into these lesions is extraordinarily uncommon.

PlayAdd to Share

Case information

rID: 43135
Case created: 25th Feb 2016
Last edited: 25th Feb 2016
System: Urogenital
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.