Metastases from Lung Adenocarcinoma as Cause of Liver infarcts and its

imaginologic diagnosis

ABSTRACT:

Pulmonary malignancy is, proportionally, the most lethal cancer. We report a case of a patient
with lung malignancy, 78 years old,former smoker, diagnosed with invasive pulmonary
adenocarcinoma EGFR “wild type” (wt), with initial TNM T3 Nx Mx. In follow up evidenced by
abdominal computed tomography, liver metastases was found, but after performing MRI,
there was a doubt between the diagnosis of disease progression or areas of hepatic infarction.
The use of gadoxetic acid (Primovist) suggested hepatic metastasis with secondary vascular
involvement, causing extensive infarct of the liver parenchyma, and signs of peritoneal
carcinomatosis. The patient died about 11 months after the diagnosis. The hepatobiliary
contrast adds a new perspective in the management of focal hepatic lesions, and has proved to
be a valuable adjunct to solving specific diagnostic issues.

Key words : Lung cancer; metastases ; MRI image

Pulmonary malignancy is the most lethal cancer comparing to the survival

rates of pancreatic head cancer ( nos anos de 1930) . Smoking is the main risk cause, although
it can occur to people that are passively exposed to the smoke or never smoker . The
pulmonologist role is unique, particularly in the early diagnosis and in the accurate staging,
due to the aggressive nature of the disease. With initial treatment responses, it is now possible
to increase the chances of survival in about 30% with the advance of targeted therapies,
tyrosine kinase inhibitors and immunotherapy . With prolonged treatment, more situations
related to this diseases’ progression occurred.

A male patient, 78 years old, with a past history of coronary artery disease,
former smoker with 64 pack-years, 8 months ago diagnosed with invasive pulmonary
adenocarcinoma EGFR “wf”, with initial TNM T3 Nx Mx. Underwent a left upper lobectomy and
lymphadenectomy, when it was confirmed N2. Adjuvant chemotherapy with paclitaxel and
carboplatin, was stoped after one cycle for peripheral neuropathy. In follow up abdominal
computed tomography (CT) suspected liver metastases, and weekly gemcitabine was
beggining , but developed sepsis. After performing magnetic resonance image (MRI), there
was a doubt between the diagnosis of disease progression and areas of hepatic infarction. By
loss of performance status, an observational strategy was determined, since there was no
window treatment or biopsy benefit. With the loss of liver function, an abdomen ultrasound
with liver's Doppler was performed, but again, infarcted areas were suggested, with associated
portal hypertension. After that, there was a discussion between clinical oncology, pulmonology
and radiology groups and the MRI using gadoxetic acid (Primovist) was decided. This exam
highlighted areas of hipovascularization which suggests metastasis with secondary vascular
involvement, causing extensive infarct of the liver parenchyma, and signs of peritoneal
carcinomatosis. The patient died 11 months after the diagnosis
 Pulmonary malignancy appears as high aggressiveness (que o cancer
pulmonar é bastante agressivo). The richness and plurality of secondary onsets of this
pathology are still a diagnostic challenge to those who take care of these patients (( talvez
quer dizer comprometimento secundario da doença ). The hepatobiliary contrast adds a new
perspective in the management of focal hepatic lesions, and has proved to be a valuable
adjunct to solving specific diagnostic issues, such as injuries.

FALTA

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