What happened, in summary

An 82-year-old man with metastatic lung cancer and a BRCA2 functional variant developed rapidly worsening disease. A large right adrenal metastasis grew to about 11 cm and invaded adjacent structures. New disease appeared in the left adrenal gland, while bone, pleural, pulmonary and retroperitoneal nodal metastases also worsened.

The growing tumor burden compressed and blocked the inferior vena cava and iliac veins, causing severe swelling of the legs and scrotum, ascites, body-wall edema and shortness of breath. Imaging showed complete vena cava obstruction from tumor, clot and external compression.

He underwent a complex endovascular procedure to reconstruct the iliac veins and inferior vena cava with multiple stents. The procedure restored forward venous flow and had no immediate complications. The intervention was palliative and addressed the consequences of progressive metastatic disease rather than treating the lung cancer itself.