Abstract Introduction Uterine cancer is the most common gynecological cancer in the world, with typical metastatic sites including pelvic and paraaortic nodes as well as the lungs. Atypical sites include extra-abdominal lymph nodes, liver, and brain. Here, we present the case of a woman with rapidly progressive atypical metastasis leading to trachea compression requiring urgent intubation. Case Presentation A 54-year-old female with a history of stage III uterine cancer status post chemotherapy and radiation presented initially for chemotherapy-induced anemia after completing her fourth cycle of chemotherapy. While her anemia resolved, she remained hospitalized due to difficulty with pain control and lower extremity Deep Vein Thrombosis. Three weeks into her hospitalization, she became dyspneic with physical exam significant for audible wheezes. Initial differentials included mucus plugging, pleural effusions, atelectasis, respiratory depression due to heavy opioid burden, and upper airway stenosis. CT thorax revealed bulky mediastinal lymphadenopathy extending into the left neck and supraclavicular regions resulting in mass effect causing significant tracheal compression in the subglottic region as well as the left mainstem. Patient’s respiratory status continued to worsen, having stridor with inspiration and expiration as well as difficulty speaking. She understood the futility of CPR and decided to become DNR. However, the patient opted for intubation and was intubated by anesthesia due to impending respiratory failure. Bronchoscopy was performed demonstrating only a scant amount of mucus. After a goals of care discussion with family, the decision was made for palliative extubation and comfort measures. Discussion Progressive dyspnea and stridor in a cancer patient with potential mediastinal lymphadenopathy should raise immediate concern for tracheal compression. Our patient displayed stridor, worsening dyspnea, and difficulty speaking, all signs of impending respiratory compromise. Early recognition allows for a comprehensive management plan, including consideration of tumor debulking, airway stenting, and alternative airway strategies in anticipation of a high-risk intubation. Equally important, early identification provides the opportunity to address the ethical considerations surrounding continued intervention in a terminally ill patient. In this case, consent for intubation occurred while the patient was already in significant respiratory distress, raising the question of whether she truly understood that intubation would not reverse her condition, or whether she pursued it primarily for symptom relief. This case highlights the importance of early recognition of airway compromise in oncologic patients to guide the appropriate medical and procedural approach and allow meaningful discussions regarding prognosis, goals of care, and whether intervention is truly indicated. This abstract is funded by: None
Syed et al. (Fri,) studied this question.