What could be hidden behind acute respiratory failure causing emergency intubation

This paper describes an uncommon case of acute respiratory failure in a patient who presented with low a haemoglobin rate and metabolic acidosis but with normal vital signs. He had a history of persistent atrial fibrillation, long-term therapy with coumarin anticoagulants and amiodarone, diabetes mellitus, and hypothyroidism. The patient was intubated due to severe acidosis, accumulation of lactic acid, and severe tachypnoea. During the investigation, and based on CT findings, it was thought that the patient had an upper gastrointestinal tumour. However, the results of the endoscopy were surprising. This paper outlines our comments, concerns and thoughts for an uncommon case which can present a potentially life-threatening situation for a patient. It also indicates the appropriate clinical and imaging investigation. Moreover, recommendations are given to enable a physician to offer the best possible services to a critically ill patient.