Wednesday, November 02, 2005

Follow-up to abnormal CxR

This is the woman in her 70s with an abnormal CxR. Everyone picked up on the loss of volume and nobody was "fooled" by the negative CT last year (it was really unremarkable). She had a CT scan seen below:

Most of her L lung was collapsed with a smallish effusion. Her effusion was exudative with negative cytology. I did a bronch and she had a NSCLCa occluding her L mainstem bronchus. Her Spiro (with her L lung collapsed) revealed an FEV1~ 800cc.
What would you suggest as the next step?

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

Jennings said...

Well, that there was collapse of the lung due to the cancer makes it a T3 (thus whether the lesion was more than 2cm from the carina is not an added consideration since it's already a T3). The negative effusion is good (thus avoiding a T4 classification). If there are no nodes, this could conceivably still be a stage IIb wich would make it amendable to surgery. The poor FEV1 is likely not to be as bad once the collapse is resolved, therefore this is not necessarily a sign of inoperability. I would get a PET to help determine if there is mediastinal involvement. If, after tht workup we are still left with a stage IIb, I would refer him to CT surg. As far as the FEV1, again, the CT *suggests* that the other lung is relatively free of severe emphysema...

Mendez said...

I agree that a w/u for metastic disease should be next (PET scan; did CT pick up any suspicious lever lesions?)
However, in terms of operability; She may need a pneumonectomy which would make her residual Fev1 ~800 since that's were measuring now. What does is her %predicted? She may need Q scan and exercise study to for a better assessment.

Jeff H said...

I'd just do the quantitative V/Q scan and, if borderline, a CPET.