This is an 83 y/o man sent to us by our CT surgeons. Two months ago he had a tracheo-bronchitis treated by his PCP. A CxR showed a subtle abnormality on his L lung and that was better seen on a CT scan. He is now assymptomatic but has a persistent abnormality on his L lung on a repeat CT scan (see below, this was done roughly 6 weeks after the first one).
He is a former smoker (quit in 1967) with no other remarkable exposures.
Exam is fairly normal.
PFTs showed mild COPD (FEV1~70% with normal TLC, increased RV and DLCO ~60%).
The surgeons thought we might want to see him before cutting anything out.
What would you do next?
2 comments - CLICK HERE to read & add your own!:
This is a dump from surgeons. Ask pt what he wants and document. If there is any doubt about his competency, involve DPOA/family members for the decision making. Most of the elderly do not want surgery even if it is a curable cancer. And I do not blame them. QOL is the most important thing at this stage, not the longevity.
I agree; this sounds like an otherwise healty 83 year old and, unless there are compelling reasons otherwise, should receive the standard of medical care. In this case, I think a staging PET is reasonable and, and unless unexpected lesions are encountered the patient should be offered the potentially curative surgery.
I can't say that this is definitely not an infection, but I would expect an infection to have resolved radiographically in 6 weeks.
Post a Commenttest post a comment