A case of obstructive shock and transient ischemic attack from intracardiac metastasis of non-small cell lung cancer (NSCLC)

Introduction: Cancer-associated stroke (CAS) is a serious complication in cancer patients, particularly those with lung cancer. This case highlights a 76-year-old male with metastatic squamous cell carcinoma of the lung who developed obstructive shock and a transient ischemic attack (TIA) due to intracardiac metastasis. Case presentation: The patient, with a history of coronary artery disease, chronic atrial fibrillation, and obstructive sleep apnea, was diagnosed with stage IIIB squamous cell carcinoma of the lung. Imaging revealed a tumor thrombus in the left atrium, extending from the right lower lobe of the lung via the pulmonary vein. The patient presented with hemodynamic instability and a fall. A TIA with right facial droop and left pronator drift developed, which resolved within six hours. Given his poor performance status (ECOG 3), he was started on palliative radiation therapy and discharged to hospice care. Clinical discussion: Intracardiac metastasis is a rare complication of lung cancer, leading to severe hemodynamic issues and neurological events like stroke. In this case, the tumor thrombus caused obstructive shock and increased the risk of ischemic stroke. Cancer-associated stroke is more common in patients with thoracic malignancies, underscoring the need for a multidisciplinary approach to manage these complex cases. Conclusion: This case highlights the importance of early recognition and a multidisciplinary approach in managing cancer-associated strokes, particularly in patients with advanced lung cancer. Palliative care is essential for symptom management and improving quality of life. Further research is needed to explore targeted treatments for cancer-associated thrombosis.