This is a 65-year-old male patient, smoker of 40 packs/year, hypertension with good pharmacological control, myopia and operated on from cataract right eye 5 years earlier, as the most remarkable history.
The reason for consultation at the Cardiology Department of our hospital was a one-month history of a non-central scotoma in the right eye.
She had no respiratory symptoms or constitutional symptoms.
In the papillary exploration, an image of depigmentation was identified in the upper portion of the papilla, with pigmented areas at the edges of the center, with a 4-5-diameter rise.
Fluorescein angiography was performed, which again revealed the same lesion as described in colonoscopy. A hematoma or hemangioma was ruled out.
Orbital ultrasound showed a mass of 7 x 3 millimeters (mm) in diameter, with an elevation of 3 mm. Magnetic resonance imaging of the orbital region was performed, in which there was no apparent focal contrast administration near the thick papilla.
A month later a new radiography and ultrasound showed a clear increase in orbital lesion, possibly reaching 9.6 x 3.9 mm. The diagnostic approach was tumor size.
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In the general search for the primary tumor, a computerized tomography (CT) of the non-obstructive pulmonary lobe is performed in the left upper lobe and a pre-vascular nodule of 2.2 cm is seen in the upper bronchus.
Abdominally, bilateral adrenal nodules measuring 2 cm in the left and 1.5 cm in the right are highlighted.
Positron emission tomography (PET) showed multiple foci of high metabolic activity at the right paratracheal level, mediastinum and hiliar region and left parahiliar region all compatible with malignant tumor, adrenal region.
Mediastinoscopy was performed for biopsy of a right paratracheal adenopathy, which resulted in metastasis of adenocarcinoma.
With the diagnosis of right metastases and adrenal metastases from lung adenocarcinoma, chemotherapy treatment with docetaxel and cisplatin was started, showing after two cycles of the treatable disease and an apparent improvement in the retina, a mild radiotherapy was subsequently treated, although partial improvement was observed.
