A 45-year-old woman with metastatic lung cancer presents to the emergency department with acute onset dyspnea and pleuritic chest pain over 2 days. She has been hospitalized for 5 days following chemotherapy and has been mostly bedbound. Vital signs: BP 128/82 mmHg, HR 106/min, RR 22/min, SpO2 89% on room air, temperature 37.2°C. Physical examination reveals decreased breath sounds at the right lung base; no lower extremity edema, erythema, or calf tenderness. Chest X-ray shows a new peripheral wedge-shaped opacity in the right lower lobe with an effusion. D-dimer is 2.8 μg/mL. CT pulmonary angiography is being considered. Which of the following is the most likely diagnosis?
- A)Pulmonary embolism with infarctionGABARITO
- B)Chemotherapy-related acute lung injury
- C)Metastatic disease with malignant pleural effusion
- D)Community-acquired pneumonia superimposed on aspiration
- E)Spontaneous hemothorax from tumor necrosis
Explicação
Pulmonary embolism with infarction is the most likely diagnosis. The classic clinical triad is present: (1) acute onset dyspnea and pleuritic chest pain, (2) risk factors including recent hospitalization, immobility from cancer, and chemotherapy-induced hyperc... Ver explicação completa e trilha adaptativa →