Shortness Of Breath In A Lung Cancer Patient

A 53 year old male with known metastatic non-small cell lung cancer was admitted with a one-week history of increasing shortness of breath. During the four months prior to his admission he had been treated with cisplatin-based chemotherapy, and had undergone left sided thoracenteses at 3-4 week intervals, the most recent, 4 weeks prior to admission. On admission, the patient was dyspnoeic, his pulse rate was 110/min, respiratory rate 28/min, and blood pressure 130/80 mmHg . He had moderate jugular venous distension and diminished breath sounds in the lower half of his left lung. Heart sounds were relatively loud and no murmurs were evident. The abdomen was soft and the liver moderately enlarged. There was mild oedema of both lower extremities. ECG revealed a sinus tachycardia with normal voltage. The chest X-ray prior to the last thoracentesis is shown in figure 1, and that from the current admission in figure 2. Figure 1 Shortness Of Breath In A Lung Cancer Patient