Metastatic  carcinoma of supra-renal gland to pleura


    This patient  was admitted through emergency department. The patient has 6 months history of respiratory tract infection. his is was followed by left sided empyema. Drainage was tried 3 times during these 6 months. complete collapse of left lung with chronic encysted empyema thoracis.

On exam:
    Generally, patient is underweight and cachectic.
    palpable left medial axiliary lymph nodes which are firm, mobile and tender.
    There was clubbing of nails (1st degree)
    Microscopic hematuria

Chest x-ray of the chest, P-A and lateral

USS abdomen revealed a lesion of the upper pole of the kidney with poor distal shadowing.
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The following procedures  were performed:

  1. Rigid bronchoscopy showed normal uvula, vocal cords, trachea, carina and right bronchial tree. Blood was found coming from Left bronchial tree but normal bronchial mucosa was seen after suctioning.
  2. Left postero-lateral thoracotomy. The parietal pleura was about 1 inch thick. It was hard and fixed to the chest wall. Adequate parietal pleurectomy was performed with difficulty. The left lung was completely collapsed. Trial of manual infiltration failed. The mediastanium was firm and covered with a thick fibrous tissue layer.

Specimens from the left parietal pleura were sent for microscopic examination showed no growth of organisms butt no acid fast bacilli were seen.

Histo-pathological features are consistent with metastatic carcinoma.

A lesion was discovered in the upper pole of the left kidney suggestive of primary supra-renal gland lesion. Patient was referred to the oncologist and his advice was as followed:
" Since patient is cachectic with poor general condition, he is beyond any active treatment.

Patient's condition was discussed with the relatives. Relatives will take the patient back home with an escort.