What happened, in summary

A 60-year-old woman with a heavy smoking history presented with several weeks of headaches and dizziness. Brain MRI showed innumerable bilateral lesions suspicious for metastases, and chest imaging found a 2.2 cm right upper-lung mass with extensive hilar lymphadenopathy. A lymph-node biopsy confirmed lung adenocarcinoma. Molecular testing identified KRAS G12C and EIF1AZ alterations, and PD-L1 expression was 30%. The cancer was classified as Stage IV with brain metastases. During the diagnostic workup, a CT angiogram also found a new blood clot in the proximal aortic arch, despite no structural aortic disease or other clear hypercoagulable condition. She was treated with anticoagulation for the clot. For the cancer, she completed 2 weeks of whole-brain radiation. Carboplatin, pemetrexed and pembrolizumab were planned next but had not yet started. Her case highlights the challenge of managing extensive metastatic lung cancer alongside a serious cancer-associated clotting complication.