SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Dilemma: Metastatic Adenocarcinoma of the Lung Camouflaged by Covid-19 History

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A 61-year-old non-smoking woman with a history of two prior COVID-19 infections and long COVID developed progressively worsening dyspnea over five months. She was repeatedly treated for presumed pneumonia with antibiotics and steroids without improvement. Initial hospital workup showed neutrophilic leukocytosis, and chest CT angiography demonstrated multifocal bilateral ground-glass opacities with consolidation, along with mediastinal, cervical, and left axillary lymphadenopathy. She was initially diagnosed with cryptogenic organizing pneumonia.<br /><br />Pulmonology planned bronchoscopy, but she could not tolerate lying supine because of oxygen desaturation, so she was managed conservatively with broad-spectrum antibiotics and steroids. Her respiratory status worsened after discharge, with oxygen needs rising to 10 L/min. Three weeks later, she returned with acute hypoxic respiratory failure requiring high-flow nasal cannula by day and BiPAP at night.<br /><br />Because of persistent symptoms, a broader infectious and autoimmune evaluation was performed and was negative. Repeat chest CT again showed diffuse bilateral ground-glass opacities and mediastinal lymphadenopathy. On exam, a palpable cervical lymph node was found, allowing ultrasound-guided biopsy. Pathology revealed metastatic adenocarcinoma of pulmonary origin. Subsequent brain MRI showed at least eight brain metastases, and abdominal CT revealed a liver lesion. She was diagnosed with stage IVB non-small cell lung cancer, adenocarcinoma subtype.<br /><br />This case highlights a diagnostic pitfall: COVID-19 and long COVID can produce imaging findings similar to lung adenocarcinoma, delaying cancer diagnosis when tissue sampling is difficult. The authors emphasize that malignancy should be carefully excluded in patients with prior COVID-19 who present with persistent bilateral ground-glass opacities and respiratory decline.

Asset Subtitle

Sharon George

Meta Tag

Author List Kendra Calvin, Sharon George

Category Clinical Vignettes

Concept Dyspnea

Concept Metastatic Lung Adenocarcinoma

Concept Non-Small Cell Lung Cancer

Concept Differential Diagnosis

Concept Malignancy Workup

Distinguished Non-Finalist

Presenter Organization Texas Health Resources

Presenting Author Sharon George

Track Adult

Keywords

COVID-19

long COVID

ground-glass opacities

lung adenocarcinoma

non-small cell lung cancer

metastatic disease

mediastinal lymphadenopathy

acute hypoxic respiratory failure

cryptogenic organizing pneumonia

brain metastases

Dyspnea

Metastatic Lung Adenocarcinoma

Non-Small Cell Lung Cancer

Differential Diagnosis

Malignancy Workup