Atypical Presentation of Non-small Cell Lung Carcinoma

The typical presentation of non-small cell lung carcinoma (NSCLC) is hemoptysis, dyspnea, and chest pain. A late cancer diagnosis commonly leads to the patient presenting with metastasis to the bone, liver, adrenal glands, or brain. We present a 58-year-old man who visited the emergency department with a headache for two weeks. A CT scan of the brain revealed a right posterior parietal mass with surrounding vasogenic edema and sulcal effacement as well as a large mass arising from the sella. The patient underwent mass resection, and the pathology results indicated a metastatic adenosquamous carcinoma of the lung. The patient later returned to the emergency department with dyspnea and a cough, and a thorough work-up indicated the patient was suffering from cardiac tamponade secondary to metastasis. The patient underwent a pericardiectomy, pericardial window, and thoracentesis with thoracostomy tube placement. One liter of pericardial fluid was removed, and he was discharged with follow-up for outpatient treatment. Overall, this patient has a poor prognosis due to the presentation of metastases to the brain and pericardium. This case underscores the importance of considering NSCLC in patients with unusual central nervous system presentations and highlights the rare but critical manifestations of pituitary and pericardial metastases. Given the poor prognosis associated with metastatic cardiac tamponade and pituitary involvement, early recognition and symptom management are essential to optimizing patient outcomes.