Acute hemorrhage into adrenal metastasis from NSCLC
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 hemoglobin.
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Pre-chemotherapy CT performed 10 days earlier shown in series 2 and 4.
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 hemorrhage (arrow). This explains the right sided pleuritic symptoms and hypotension. No signs of PE.
Spontaneous hemorrhage into adrenal metastasis is rare and usually associated with melanoma. Lung cancer metastasis to adrenals is common but hemorrhage into these lesions is extraordinarily uncommon.
- Oo T, Martin L, Hesketh P. Clinical Lung Cancer. 2002;4 (3): . doi:10.3816/CLC.2002.n.026