ACUTE RESPIRATORY FAILURE AS PRESENTING SYMPTOM OF GI MALIGNANCY

TOPIC: Imaging TYPE: Fellow Case Reports INTRODUCTION: The causes of acute respiratory failure are numerous, requiring providers to have a broad diagnosis when approaching patients with failure. Malignancy (either from primary lung tumor or metastases) typically present as focal lesions. Ground glass opacities and septal thickening not usually associated malignancy, but rather interstitial diseases, congestive heart failure, infections. This case is unique the presenting symptoms gastrointestinal malignancy were cough that developed into rapid CT findings ground opacities. CASE PRESENTATION: A 33 year old female presented clinic 7 week history non-productive cough. She was hypoxic chest revealed bilateral opacities, nodular mild mediastinal lymphadenopathy. After being admitted hospital, patient underwent transbronchial biopsy. severe hypoxia coughing post-bronchoscopy had be re-intubated transferred ICU. repeat more extensive small pleural effusions, increasing TTE showed severely depressed right ventricular systolic function wall flattening. These results, coupled worsening hypoxia, prompted initiation inhaled epoprostanol, steroids, spectrum antibiotics. ultimately required ECMO cannulation due hypoxia. Her bronchial washings non-specific, biopsy concerning for lymphatic invasion by epithelial cells positive AE1/AE3, CK7, CDX2, CK20. suspicious metastatic GI pancreatobiliary origin. her chest, abdomen, pelvis consolidation throughout lungs no evidence tumor. did multiple enlarged retroperitoneal lymph nodes. Further workup unable completed clinical instability. Worsening hypotension persisted, she died 23 days after initial presentation. DISCUSSION: median survival gastric cancer less than 1 3-6 months pancreatic cancer. Overall rate metastases 0.5-0.9%, 15%. Metastases hematogenous, spread, seen in 26% cases. Given low these malignancies, accurate timely manner upmost importance. CONCLUSIONS: nodularity an uncommon presentation pulmonary metastases. decline our patient's status, it beneficial consider differential all vague on imaging. REFERENCE #1: Kong JH, Lee J, et al. Lung cancer: pattern metastasis outcome. Gastric Cancer. 2012;15:292–298. #2: Liu KH, Hung CY, Patients Stage IV Pancreatic Cancer: Prevalence, Risk Factors, Survival Impact. J Clin Med. 2019 Sep 6;8(9):1402. DISCLOSURES: No relevant relationships Kaitlin Branick, source=Web Response John McClain, Amol Patil, Jake West,