Correct!
2. Pancreatic cancer is not associated with hypercalcemia
In caring for patients with multiple illnesses care must be used in evaluating for treatable illnesses. Although pancreatic cancer is not as commonly associated with hypercalcemia as some other cancers such as breast and lung, essentially any tumor may cause hypercalcemia (2). Her calcium was normal. Her glucose was low at 34 mg/dL and brain natriuretic peptide was elevated at 1396 pg/ml. Therapy was initiated with furosemide. However, she did not improve and her arterial blood gases remained abnormal with a pH 7.45, pCO2 45, pO2 42 on 2L/min by nasal cannula. She underwent bronchoscopy with bronchoalveolar lavage which revealed normal bronchial anatomy. Smears and cultures were all negative.
Her thoracic CT scan was repeated due to her persistent hypoxia despite diuresis. This scan was interpreted by the radiologist as improvement of the scattered groundglass nodular opacities since her previous CT scan. See representative samples shown below (Figure 3).
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Figure 3. Movie of the axial images from the thoracic CT scan performed 5 days after the initial thoracic CT scan (figure 2).
What is the most likely diagnosis?