Monday, December 05, 2005

Abnormal CT scan

This is a 44 y/o man referred to our office because of an abnormal CT scan of the chest. He had fallen of a horse and had a CT scan of his thoracic spine and the mediastinal findings were incidental. He has NO respiratory symptoms. He is a smoker (1-1.5 pack/day x ~30years) and has normal PFTs. I have outlined the abnormality on the first cut so you may follow along. No other parenchymal abnormalities were noted.

How would you (or would you) work up this lesion?

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

Mendez said...

It certainly is hard to ignore given the size. However, there does appear to be some calcification at the lowest cut. There also appears to be a paratracheal node that is calcified. I wonder about Histo exposure in the past.
Additional questions:
What area of the country is he in or has he been?
PPD status/risk factors?

Assuming that he has no prior ragiographs and that I'm wrong about the calcification HRCT?)- I think that a PET scan might help guide the next step. If nodes are positive - I would consider Med-scope for Dx. If negative - a f/u CT scan in 3 mos. to assess for change / progression.
Other thoughts? How about you JJ - haven't heard from you in a while.

Baleeiro said...

He is from Tennessee, which is also histo country. You are right on the other calcified node. No known TB exposure and he has no respiratory symptoms.

Jeff H said...

I agree with a PET now, and biopsy if it is +, follow-up radiographs if negative.

I'm not sure, however, that a mediastinoscopy can access that pre-vascular region...

Mendez said...

True... probably a Chamberlain (anterior mediastinotomy) then.

Mike L said...

I am not so sure a negative PET scan would be very helpful to me. It could be a lymphoma in the prevascular lymph nodes and be PET negative. Also, slow growing lymphomas are notorious for being "stable" for 2 years on CT scan.
I would send him to thoracic surgery for a biopsy.