What would you do next?
Thursday, January 26, 2006
Radiology Thursday (for Mendez)
This is a previously healthy 21 y/o woman who works at a local hotel and gets periodic PPDs. She had a negative PPD last year and is a new converter with a new + PPD. She has no respiratory symptoms whatsoever. The health Dept was going to start INH for LTBI but she had a nodule on CxR (outside films, I can't post them) and we got the following CT scan.
What would you do next?
What would you do next?
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3 comments - CLICK HERE to read & add your own!:
1. It looks like a hamartoma on the CT to me. I would only re-check the CT in 3 months if in doubt. (?any old CTs/CXRs)
2. I would induce sputum to check for AFB.
3. Contact Screening
4. She qualifes as a PPD 'converter' and would need prophylaxis.
This could very easily be a hamartoma, although classically these are more peripheral. I don't see any calcification, but that doesn't rule out the diagnosis.
So, I would do a repeat CT scan with thin cuts through the lesion to determine if that is, in fact, fat density.
As to treatment for LTBI, I agree that, as a new converter she would need treatment for LTBI. I agree that this should wait until the nodule is further characterized and either sputum or BAL culture is negative.
We have started her on treatment for LTBI and she has done very well with that. The density measurements were of fat tissue in the center and my impression (and that of our radiologist) was the same as yours: that this looks very much like a hamartoma. She has had a repeat CT (~3.5 months after the initial one) and the lesion is very stable. We can actually see it on plain Cxr and with fat tissue in a young non-smoker I have been pretty confident this is not much to worry about though we are following her with CxRs.
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