CLINICAL PROBLEMS IN CARDIOPULMONARY DISEASE Metastatic Tumor and Pseudomonas Problems of Dagnosis and Managemenf

Routine laboratory data were within normal limits. The chest x-ray film was unremarkable ( Fig 1 ). The results of bilateral pulmonary tomographic studies, two bronchoscopic examinations, five sputum cytologic studies, an intravenous pyelogram, and a complete gastrointestinal series were unremarkable. A brain scan showed multiple areas of increased radioisotopic uptake present bilaterally. These findings were compatible with metastatic carcinoma. A carotid arteriogram showed several defects, including a deep mass in the posterior parietal occipital area ( Fig 2). An electroencephalogram was abnormal, showing mild generalized slowing, suggestive of a diffuse process; there was focal slowing in the right temporal region, indicative of a structural lesion in this area. The spinal fluid-was clear, with a high opening pressure ( manometric reading considered unreliable due to poor cooperation of the patient).