Lung cancer is the leading cause of global cancer mortality. It is also the third most common cancer in the United Kingdom and the most prevalent worldwide. Pulmonary nodules can indicate early-stage lung cancer, but adherence to guidelines for radiologic surveillance is suboptimal, which affects early detection and treatment. Although interventions have been developed to improve follow-up, it remains unclear which approaches are most effective.

A 73-year-old man presented with a 2-week history of intermittent right-sided chest pain, cough, and progressive dyspnea on exertion. He reported subjective weight loss and anorexia with early satiety over the preceding months. He denied any fevers, night sweats, or sick contacts. On further questioning, he had also noted some progressive abdominal distension, though denied any change in bowel habits, nausea, or vomiting. He had a history of hypertension and diabetes. He was a person who does not smoke and had worked in the construction industry for > 50 years prior. His daughter had passed away due to lung cancer.

A 52-year-old woman presented to the clinic with progressively worsening shortness of breath associated with intermittent pleuritic left lower back pain for the past 6 months. The patient denied any cough, hemoptysis, fever, chills, or weight loss. She had a history of smoking cigarettes for more than 10 years but quit almost 20 years ago. An outpatient chest radiograph was obtained, and it suggested consolidation of the left lower lobe. The patient was treated empirically with amoxicillin-clavulanate for 2 weeks without improvement.

A 71-year-old man with a history of atrial fibrillation presented to the emergency department with sudden unconsciousness after finishing lunch. Just 4 weeks ago, the patient underwent radiofrequency ablation for atrial fibrillation and regularly took rivaroxaban for anticoagulant therapy. According to the medical history, the patient suffered recurrent chest tightness and heartburn after radiofrequency ablation without other discomforts. During transportation to the hospital, the patient experienced a drop in BP after forceful vomiting.

Inhalation of elemental mercury is a rare cause of ARDS, with limited published case reports to provide guidance regarding disease progression and management. Although extracorporeal membrane oxygenation (ECMO) has been used to treat toxin-induced lung injury, its application to initial treatment and long-term recovery for inhalation of mercury remains undescribed. We present a case of a 56-year-old man who works at a thermometer factory presenting with severe ARDS secondary to inhaled elemental mercury with confirmatory blood and urine mercury levels. Respiratory recovery and avoidance of neurologic and renal sequelae from elemental mercury was successfully accomplished with venovenous ECMO, steroids, and simultaneous dual-chelation therapy. This case demonstrates the efficacy of venovenous ECMO for severe inhalation of elemental mercury pulmonary injury and the utility of dual-chelation therapy for avoiding late development of neural and renal pathologic conditions and provides novel insight into the impact of ECMO circuits on blood mercury levels.