An 83-year-old woman, nonsmoker, hypertensive, with a history of right hemicolectomy for tubular adenocarcinoma of the colon three years earlier.
She did not receive postoperative radiotherapy or chemotherapy.
Two years later, an incisional hernia was repaired.
In September 2005, the patient was admitted to another hospital due to fever and dyspnea at rest.
On physical examination, the absence of pulmonary murmur on the left stood out, as well as hypoxemia, hyperventilation, anemia (hemate) revealed 33%, leukocytosis (23,000 mm3) and elevated ESR (89 mm/h).
A chest X-ray showed complete atelectasis of the left lung.
The picture was interpreted as a pneumonia and ceftriaxo-na was indicated.
Bronchoscopy (BFC) revealed a large hard, mucous plug that occluded the entrance of both lobes.
It was possible to partially permeate the bronchus causing significant bleeding.
In doing so, he drained abundant purulent secretion.
Patient was discharged 15 days later.
Computed tomography was not performed during hospitalization.
One month after discharge, the patient presented to the emergency department with progressive dyspnea, cough and mucous expectoration.
Again, the pulmonary murmur was abolished and the left hemithorax was killed with chest X-ray showing worsening.
The anemia persisted and there was leukocytosis of 17,700 mm3.
Cefuroxima was indicated, as well as intensive respiratory therapy and nebulizations with hay and ipatropium bromide.
With this, re-expansion of the left lung was achieved.
Days later, atelectasis recurred, with complete closure of the left lung and deviation of the ipsilateral trachea.
A CFNB showed that the trachea and the right tree were normal and in the left bronchus, at 2 cm from the main carina, there was a whitish lump in the lumen obstructing the bronchial passage completely.
The cytology revealed malignant cells and the biopsy, a bronchial mucosa caused by a moderately differentiated tubular adenocarcinoma, with the appearance of a colonic carcinoma.
Immunohistochemistry was positive for cytokeratin 20 and negative for cytokeratin 7, supporting the colonic origin of the tumor.
A computed tomography scan of the chest showed a tumor that completely occupied the left bronchus source, bilateral mediastinal adenopathies and a hydatid cyst classified in the left lobe of the liver.
1.
Radiotherapy was proposed and rejected by the patient.
She was discharged with indications for home oxygen therapy and use of oxygen as needed.
The patient, all months after discharge, survives without requiring new hospitalizations.
