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The diagnosis of malignant disease: Sometimes a matter of pure chance

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ABSTRACT

Introduction. Renal carcinomas represent 3% of malignancies in adults. The classical triad of renal tumors is: macroscopic hematuria, flank pain and a palpable abdominal mass.

Case report. We present a case of a 59 year-old man who was admitted to the Clinical Emergency Hospital of Bucharest for cough and mucopurulent sputum, dyspnea at rest and pain in the lumbar spine. The onset of symptoms was gradual, a few months prior to seeking medical advice. The initial diagnosis was: hypoxic re- spiratory failure, acute exacerbation of chronic obstructive pulmonary disease, pulmonary sequelae posttuberculosis, pulmonary hypertension, lumbar disk hernia and primary hypertension. Despite the treatment for his illnesses, his condition worsened and a new diagnosis was sought. By reassessing his condition and using imaging studies, we arrived to the correct and final diagnosis which could explain his whole clinical picture: bone metastasis from a renal cell carcinoma alongside hypoxic respiratory failure caused by chronic obstructive pulmonary disease and pulmonary sequelae posttuberculosis.

Conclusion. In this case report we demonstrate that hypoxic respiratory failure and bone pain can lead to the incidental diagnosis of a renal cell carcinoma.

Keywords: renal cell carcinoma, bone metastasis, respiratory failure.

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Ion Calin Dumitras, Claudia Ionescu and Camelia C. Diaconu

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