A 76-year-old woman had a diagnosis of metastatic colon cancer. After surgery and chemotherapy, there was only a solitary metastasis in her right hepatic lobe, close to the capsule. The oncologist decided to treat this metastasis with radiofrequency.
The Medical Oncologist
I, m going to treat this lady with radiofrequency because she is at the limit for a new surgery. I, m sure she will be fine soon
I agree with the treatment, because I trusted my doctor
The CT localized the metastases and the radiologist placed the probe inside the tumor. After several minutes the procedure was finished and the patient was transferred to the ward.
An hour later she started with fever(38 degrees centigrades), chills and shortness of breath. Because at that moment the pandemic of SARS-Cov-2 was very active, the intern evaluated the symptoms as a high probability for COVID-19 disease. The patient had shortness of breath, even resting, without a thoracic pain . She was referred to a special area settled to receive patients with a high suspicion of COVID-19 disease. At that time it was late afternoon and the nurse collected a nasopharyngeal sample for a PCR (Polymerase chain reaction) of coronavirus. The next morning, eight hours later, the result of the test arrived and it was negative for coronavirus. The doctor tried to find an alternative diagnosis.
Although the patient had a respiratory insufficiency no one before registered a proper lung examination, because of the rush originated for the pandemic. During the physical examination after the arrival of the test, the doctor detected a lack of ventilation in her right lung.
Right pneumothorax after hepatic radiofrequency to treat a solitary metastasis.
Now I feel better, but I, m afraid because I have been in the COVID area, but, the doctor asked for another PCR and it is negative again.
The fever and chills were related to the necrosis of the tumor and the liver around. The shortness of breath was a consequence of the pneumothorax, an adverse event associated sometimes with this procedure due to the proximity of the base of the lung to the liver.
- After an intervention like this try to associates an acute event with the procedure
- Think that, even during a pandemic, a patient can have another problem with similar signs and symptoms
- Never forget to do a physical examination, at least orientated to the possible source of the problem.
Author: Lorenzo Alonso, MD