Perempuan 44 tahun dibawa ke IGD pada 23 Juli 2019.

Pasien dikirim dari radioterapi karena

keluhan sesak napas sejak 1 minggu yang memberat sejak 1 hari sebelum masuk rumah sakit.
Keluhan sesak memberat bila pasien berbaring. Nafsu makan berkurang karena sesak. Batuk ada
lebih dari 1 minggu, tidak ada darah maupun keringat malam. Demam hilang timbul. Pasien makin
kurus namun berat badan tidak ditimbang. BAK dan BAB selama ini tidak ada keluhan.

Pasien diketahui kanker payudara kanan sejak 8 bulan sebelum masuk rumah sakit (November
2018). Awalnya terdapat benjolan yang semakin membesar. Sudah dilakukan biopsi dikatakan ganas
kemudian dilakukan mastektomi. Pasien kemudian menjalani kemoterapi 6 siklus, namun muncul
benjolan kembali. Pasien dirujuk ke RSCM untuk dilakukan radiasi. Namun dari hasil rontgen thorax
dikatakan terdapat benjolan di paru. Pasien direncanakan untuk bronkoskopi diagnostik.

Dari pemeriksaan fisik pasien tampak sesak berat (Breathless Numerical Rating Scale – BNRS 8/10),
takikardi, takipnea, dan didapatkan rhonki basah kasar bilateral.

A 44 years old woman was admitted to the ER on July 23rd. Patient was sent from radiotherapy due
to worsened shortness of breath since 1 day prior, accompanied with prolonged cough, loss of
appetite, fever, and loss of body weight.

Patient was diagnosed with right breast cancer since 8 months before admission (November 2018).
Mastectomy and chemotherapy were done, but after 6 cycles of chemo, the mass in her right breast
were getting large. Patient was sent to Cipto Mangunkusumo hospital for having radiotherapy.
However, chest xray showed masses were grown in her lung. Patient was planned for having
diagnostic bronchoscopy.

Physical examination showed severly ill patient with respiratory distress, tachycardia, tachypnea,
and bilateral coarse rhonchi.

Multiple irregular nodules in both pulmonary DD / Metastasis.

Cavity mass with ground glass opacity around it in the 1/2 left lung segment of DD / fungal
infection, TB, lung tumor.
Tree in bud pattern in the segment 4.5.8 DD / pulmonary right-left lung, fungal infection.
Cystic lesions in the 4th segment of the liver, DD / liver cysts, metastasis.
Blastic lytic lesions in the T7 vertebral body, DD / Metastasis.