A misleading chief complaint...

At intern report today we discussed how a chief complaint of abdominal pain led to a diagnosis of small cell carcinoma with metastases to the liver.

Courtesy of UCSF image bank

Courtesy of UCSF image bank

Main learning points include:

1. Small Cell Lung Cancer is aggressive:  It typically presents with metastatic disease as it has a rapid doubling time.  SCLC is typically highly responsive to systemic therapy, though commonly relapses.

2. The most common organs of SCLC metastases are liver, bone, brain, lung, and adrenal glandsOncol Lett. 2012

3. Small cell lung cancer is associated with SIADH.

4.  An illness script for acute on chronic mesenteric ischemia: A patient with known vascular disease and atrial fibrillation with episodic, postprandial abdominal pain, decreased appetite, and unintentional weight loss with acute onset of abdominal pain out of proportion of exam, a metabolic acidosis, elevated lactate, and leukocytosis found to have occlusion of a mesentery vessel on CT angiography.