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?
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.
ReplyDeleteI 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.
ReplyDeleteI can't say that this is definitely not an infection, but I would expect an infection to have resolved radiographically in 6 weeks.