Metastatic Small-Cell Lung Cancer

This is a truly amazing case.

The patient presented with a decreased level of consciousness and possibly seizures. While in the Emergency Department the patient developed respiratory distress and had to be intubated.

CT of his chest revealed a large mediastinal mass encroaching on his left mainstem bronchus. On the upper image above (white arrow) note an almost complete collapse of the airway. The transbronchial biopsy revealed a small cell lung cancer.

The patient remained unresponsive. CT Head did not show any acute intracranial pathology.
MRI Brain (see bottom image above) revealed multiple (probably close to a hundred) metastatic lesions in every portion of the brain.

What is interesting about these lesions is the relative paucity of cerebral edema (swelling). The patient was unresponsive primarily due to a subclinical seizure activity that was evident on the electroencephalogram.

Once his seizures were controlled with Keppra the patient “woke up”.

The prognosis for his recovery and survival is extremely poor at this point. The patient will benefit from Hospice care.