Patients With Malignancy Requiring Urgent Therapy CASE 1. Central Airway Obstruction As First Presentation of Ovarian Cancer

A 73-year-old woman presented to our emergency de-partment with a 2-week history of dyspnea. Her medical history was unremarkable. Physical examination results were normal except for slightly decreased left-sided breath sounds. Blood examination showed highly elevated levels of D-dimer (1,743g/L; normal, 64 to 246g/L), without any other abnormalities. A chest x-ray showed hyperinflation of the right lung andmediastinal shifting to the left. Multislice helical computed tomography scan of the chest ruled out pulmonary embolism, but revealed a centralmass involving the carina, with complete occlusion of the left main stem bronchus and atelectasis of the left lower lobe (Fig 1, arrow). Bronchoscopy showed a central exophytic tumor with in-filtration of the main carina and complete occlusion of the left mainstem bronchus (Fig 2). Forceps biopsy specime