Introduction

Title of PosterAuthors names

Affiliations

Case PresentationImaging

Summary/Conclusion

References

Ammar Hasnie, Usman Hasnie, James Stanford, Agostino Molteni

• Syncope accounts for nearly 1% of all ER visits, resulting in a median cost of $85001,2

• Traditionally, it is divided into three causes: cardiac, orthostatic and neurally mediated

• Rarely has it been associated with malignancy, namely lung cancer

• We present a case of an otherwise healthy male presenting with syncope as his initial manifestation of lung cancer

• 45 year old African-American male presented with syncope upon standing

• No past medical history, however visited ED 1 year prior for similar complaint- no work up was done at that time

• Initial labs showed mild transaminitis but otherwise within normal limits- admitted for full work up

• EKG- Afib with rate control. Routine CXR noted a right upper lobe nodular opacity

• Follow up CT of chest demonstrated 3x4x4 mass abutting the superior vena cava (SVC) in right upper lobe

• Echo on admission noted EF 60-65%, no effusion• Imaging for staging done and liver lobe lesion found

consistent with metastasis

Case Presentation

• While hospitalized patient had increasing O2 requirement

• Repeat CT showed large right pleural effusion• Thoracentesis performed and resulted in syncopal

episode• STAT echo noted large pericardial effusion requiring

urgent pericardiocentesis with 500 cc bloody fluid drained

• Cytology positive for malignancy• Lung biopsy confirms adenocarcinoma of lung

• Syncope relatively common presenting complaint for the internist on medical wards

• To date, 9 reported cases of lung cancer associated with recurrent syncope3

• Literature indicates small cell cancer is more common in these patients- making the biopsy results surprising

• This case was likely due to the tumor compressing the SVC causing diminished blood return and insufficient cardiac output as the patient stood up

• The syncopal episode during the thoracentesis was likely due to cardiac tamponade

• While the heart may have been to blame, the lung was the source of this patient’s syncopal episodes

1. Alshekhlee A, Shen WK, Mackall J, Chelimsky TC. Incidence and mortality rates of syncope in the United States. Am J Med. 2009;122(2):181–188.

2. Sun BC, Emond JA, Camargo CA Jr. Direct medical costs of syncope-related hospitalizations in the United States. Am J Cardiol. 2005;95(5):668–671.

3. Jiang X, Zhao J, Bai C, Xu E, Chen Z, Han Y. Small-cell lung cancer with recurrent syncope as the initial symptom: A case report and literature review. Mol Clin Oncol. 2016;5(5):545–549. doi:10.3892/mco.2016.1032