PMC6220734_01
(a) Chest CT (lung window) with a yellow arrow pointing to the right hilar lung primary. (b) PET-CT scan showing an FDG-avid primary tumor in the right lung and metastasis in the liver. (c) Abdomen CT showing bilateral adrenal hypertrophy (yellow arrows).
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Computed tomography showed right hilar mass with metastasis to the liver, right femur, and ribs (Figures 1(a) and 1(b)) with biopsy revealing SCLC. The second chest CT showed extensive local infiltration of the lung cancer with widespread hepatic metastasis and bilateral adrenal hypertrophy (Figure 1(c)).
Graph showing serum sodium (blue) and bicarbonate levels (orange) from diagnosis to patient's demise. Note how serum sodium normalizes with onset of metabolic alkalosis.
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Additionally, hyponatremia which responded moderately to fluid restriction gradually normalized after the onset of metabolic alkalosis (Figure 2).