He's a patient with COPD and heavy smoking history. Abd CT was obtained b/c of some nausea.
Friday, November 04, 2005
Approach to this lesion
A physician wants some feedback regarding how to approach this lesion. This is an abdominal CT. A chest CT has not yet been done. The quesion regarding approach: get a PET? Go right to CT-guided biopsy? Get a full CT of chest first in case soemthign shows up that would make a bronch more helpful?
He's a patient with COPD and heavy smoking history. Abd CT was obtained b/c of some nausea.
He's a patient with COPD and heavy smoking history. Abd CT was obtained b/c of some nausea.
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I'd also get a dedicated chest CT to better define adenopathy and other lesions that may warrant a bronch even rather than a CT Bx.
I'd get a chest CT first. A biopsy of the posterior lesion that seems to be invading the chest wall would, if it is a primary lung malignancy, mean this is a T3 lesion at best. If the 2ng lesion is also a malignancy, it would mean that this is metastatic or two primaries.
I dedicated CT, if there are mediastinal nodes, would direct the biopsy toward those nodes. If the CT scan does not show any LAD, than I'd consider a PET scan, and preferentially biopsy the PET+ lesion (if one of the two are PET+).
Also, PFT's should be done. If there are no nodes, and only one of these lesions is malignant, than a resection (involving chest wall if necessary) would be possible.
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