ABSTRACT Introduction Acute liver failure (ALF) due to diffuse infiltrating solid malignancy without any focal lesions on radiographic imaging is rare. Case report A 70-year-old man was admitted due to mental confusion, abdominal pain, and ALF. Three years before, he had undergone a left nephrectomy for urothelial carcinoma followed by adjuvant chemotherapy. The abdominal computed tomography (CT) showed hepatomegaly and ascites. Ascitic fluid had transudate characteristics, with no malignant cells. Percutaneous liver biopsy (LB) showed diffuse liver infiltration of metastatic urothelial carcinoma. The patient rapidly deteriorated and died in a week due to ALF. Discussion History of solid cancer and hepatomegaly and/or liver failure without other obvious explanation should encourage to perform LB. Conclusion LB is warranted to avoid misdiagnosis, prolonged hospital stays, and delay in palliative care.

A dispneia é um dos sintomas que tem mais impacto tanto para o doente com doença avançada, como para o profissional de saúde com a responsabilidade de o acompanhar. Sem prejuízo de se dever aprofundar a evidência disponível sobre as indicações e eficácia da oxigenoterapia, é já vasta a informação que suporta a evidência de que o uso de oxigénio com intenção paliativa deve ser prescrito de forma criteriosa pois, à semelhança de qualquer outro tratamento, tem efeitos secundários associados e pode causar malefícios. O artigo que se apresenta é uma revisão bibliográfica das mais recentes matérias publicadas neste âmbito, com o objetivo de contribuir para melhorar a prática clínica no contexto do tratamento dos doentes em fim de vida.

Dyspnoea is one of the most troublesome symptoms for both patients with advanced disease and healthcare professionals. We still have a long path to run across, but there is already plenty of information supporting that oxygen should be carefully prescribed in end of life since as any other treatment there are side effects related to it and in many situations there seems to be no additional benefit on prescribing this therapy. The present article constitutes a bibliographic review of published data on this matter, being the main goal of the authors to contribute to improve the treatment of end of life patients.