This is the 61 y/o man with a pulmonary mass and the bony lesions that Jennings astutely thought looked like a plasmacytoma. I was also impressed by the combination of lung mass and hypercalcemia. There were no other thoracic lesions.
We started standard hyperCa++ treatment, his MS improved and his creatinine came down from 2.0 to o.8 with normalization of his Ca++.
We set him up for a CT-guided Bx of his lung mass: he developed massive hemoptysis, almost coded; we emergently intubated him and I used the bronchoscope to advance the ETT towards a selective L intubation...
He recovered and prior to re-Bx'ing we repeated a CT scan and the nodule was gone!
He went home to recover from his respiratory failure and we finished his w/up as an outpatient: no more lung masses but his bone lesions and BM Bx led to a diagnosis of multiple myeloma.
Tuesday, August 09, 2005
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It's interesting that it was MM, since a plasmacytoma is not usually associated with hypercalcemia. What was the nodule if if went away I wonder?
Do you think that the lesion was an AVM (or some other benign vascular structure) that you ruptured with the needle?
How long did you selectively ventilate him and what criteria did you use to put the tube back into the trachea?
I think the lesion was a benign red (no pun intended) herring. By the time we got him to the unit the bleeding had slowed down so we only selectively ventilated him for about the first 12 hours.
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