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The patients respiratory symptoms along with the positive

smoking history (environmental influences) with +ve family
history (Genetic presposition) with the obvious lesions seen on
CXR with parabronchial lymphadenopathy seen on CT-scan ,
highly suggest malignancy.

Pleurisy in this particular patient may be secondary to direct

invasion by the tumor.The tumor seems to damage and invade
the functional alveoli, leading to episodes of dyspnea.The
systemic symptoms of malignancy are marked to malignancy eg
anorexia, nausea, low Hb and weight loss.Displaced apex beat,
ascites , leg edema with bilateral crepitations, points to heart
failure caused by direct invasion of the precordium or secondary
to respiratory failure.
Impairment of liver function is expected as jaundice , palpable
liver clinically and elevated liver function tests in laboratory
investigations and that¶s why vitamin K should be given to
prevent bleeding tendency.
Ectopic hormone production by the lung tumor is a common
phenomenon , in this patient generalized weakness (
myasthenia-like condition) or SIADH secretion as generalized
edema and decreased sodium concentration.Focus of infection
should be present in this patient as repeated febrile episodes-
tachycardia and leukocytosis could be secondary to malignancy
obstructing the bronchi leads to stagnant pulmonary secretions.
 Pictures of respiratory distress syndrome seen in this patient as
rapid deterioration with refractory hypoxemia and diffuse
haziness with multi-organ failure, here could be secondary to
‘ underlyi÷ ‘
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