Metastatic Lung Cancer With Pulmonary Embolism, Cardiac Tamponade, and Recurrent Stroke

What happened, in summary

A 73-year-old woman was admitted with rapidly worsening shortness of breath, low blood pressure, and low oxygen levels. Imaging showed both bilateral pulmonary emboli and a large pericardial effusion causing cardiac tamponade. Emergency pericardiocentesis stabilized her circulation. She was treated with anticoagulation and later received paclitaxel and carboplatin chemotherapy. Three months later, CT showed a new star-shaped lung lesion, and biopsy confirmed a primary pulmonary cancer. Two weeks after that diagnosis, she experienced an ischemic stroke. Brain imaging also demonstrated multiple leptomeningeal metastases, establishing distant spread of the lung cancer and supporting Stage IV as the latest and highest disease stage. Despite continued anticoagulation, she had another ischemic stroke the next month due to acute occlusion of the left anterior cerebral artery and underwent successful mechanical thrombectomy. Her overall condition remained poor. She died during the following month. Her care required balancing severe cancer-associated clotting risks with the bleeding risks of anticoagulation and invasive procedures.