Tuesday, September 06, 2005

RUL mass

This is a 60 y/o woman with a 50-pack-year Hx of smoking who presented with a RUL mass. Her History is remarkable for +TB in 2003: she had a clear exposure with a small RUL infiltrate and +AFB. Her isolate was quite pan-SS and she received standard Tx (initially INH/RIF/ETH/PZA) with DOT. She was smear-negative at the end.
She is now assymptomatic but has a suspicious enlarging RUL mass. No other relevant history.
Good (almost normal) PFTs.
Bronch was AFB-smear negative and non-diagnostic.
PET scan showed increased activity (SUV~2.5) in the mass only.

What would you do next?

Answers and further discussion on the post above.

7 comments - CLICK HERE to read & add your own!:

Mike L said...

I would ask the surgeons to take it out.
That lesion is lung cancer until proven otherwise.

Jennings said...

Seems pretty straightforward - take it out. solit mass that is growing and pet positive and she has good lung function.

Jeff H said...

I'll make it 3 for 3 with resecting it. We have to presume that the pan-sensative TB was appropriately treated, and that this is unlikely to to be a failure of that treatment.

Arenberg said...

What's up y'all? For what its worth, I totally agree on sending this lady to a thoracic surgeon. The pre-test probablility that this was a cancer was high even before the positive PET scan, and with the positive PET, you can rest easy even if it turns out to be benign.

Jennings said...

Hey Doug..Hope you become a regular here!

Arenberg said...

Thanks Jeff, I actually was searching for advice on this troubling skin rash that keeps coming back, when I found you guys ;-)

Baleeiro said...

Doug, welcome. Come back and visit the blog more often.