Introduction:

Managing patients with complex comorbidities poses significant diagnostic and therapeutic challenges. This case report details a 65-year-old male with a history of decompensated chronic liver disease (CLD) and portal hypertension, who presented with symptoms suggestive of liver disease exacerbation. He was later diagnosed with primary lung malignancy and extensive thrombosis, including the inferior vena cava (IVC) and heart chambers, a rare finding.

Case Presentation:

A 65-year-old man with a history of smoking, alcohol consumption, and chronic liver disease presented with severe pain in the upper right quadrant, dyspnea, weakness, loss of appetite, and unintentional weight loss. Medical assessments revealed decompensated CLD with elevated bilirubin levels, low albumin, and an elevated INR. Transthoracic echocardiography revealed an echogenic thrombus protruding from the IVC into the right atrium. Contrast-enhanced computed Tomography (CECT) of the abdomen and pelvis displayed a large, heterogeneous adrenal gland mass with necrosis and peripheral enhancement, indicative of metastatic cancer. 

Additionally, the CECT   of the chest showed a primary lung malignancy in the right lung and an extensive IVC thrombus extending into heart chambers. Following treatment with IV fluids and antibiotics in the Emergency Room, the patient received counseling from the multidisciplinary team and subsequently opted for palliative care.

Discussion:

When dealing with primary lung cancer and adrenal metastasis, it's important to assess atypical presentations for IVC thrombus thoroughly. Even with advances in imaging and treatments, managing IVC thrombus related to cancer is still difficult and requires a team approach. The cornerstone of diagnosis is timely imaging and a high degree of suspicion.

Conclusion:

This case highlights the complexities of diagnosing and managing patients with multiple conditions. It emphasizes the need for patient-centered care and the importance of ongoing research to develop effective diagnostic and treatment strategies for conditions like IVC thrombus in the context of malignancy.

Abinash Dev has completed his MBBS from B.P. Koirala Institute of Health Sciences in Dharan, Nepal. He is a Nepalese citizen and is currently preparing for the USMLE examination. His primary research interests lie in the fields of cardiology and radiology. He has served as the lead investigator in two significant trials, contributing to his research experience. He is associated with the Department of Internal Medicine at his alma mater