A 70-Year-Old Woman With Refractory Hypoxemia

Area of Science:

• Cardiology
• Oncology
• Pulmonology

Background:

• A 70-year-old female with a history of syncope was diagnosed with a right intraventricular filling defect, pulmonary nodules, pulmonary emboli, and a left breast mass.
• The patient had significant comorbidities including diabetes, hypertension, hyperlipidemia, COPD, hypothyroidism, diastolic heart failure, and a substantial smoking history.

Observation:

• The patient initially underwent a breast biopsy, was initiated on rivaroxaban, and discharged with outpatient follow-up.
• She subsequently experienced worsening dyspnea, leading to re-evaluation at an outside emergency department (ED).

Findings:

• In the ED, the patient was found to be severely hypoxemic and required intubation.
• The initial inpatient evaluation revealed findings suggestive of metastatic disease, including an intraventricular filling defect and pulmonary emboli.

Implications:

• This case underscores the importance of considering metastatic malignancy in patients presenting with unexplained cardiovascular and pulmonary findings.
• Early recognition and multidisciplinary management are crucial for optimizing outcomes in such complex cases.