Wednesday, April 26, 2006

Follow up to Nodule and Mass

I had posted this but didn't get much feedback. This is the fairly healthy 40 y/o woman with some chronic back pain but no pulmonary or cardiac disease referred to us for a "new" pulmonary mass. She has never smoked and has had no pulmonary symptoms. She had been told about 10-15 years ago that she had a calcified R lung nodule and that has just been followed along. However she had had recent imaging for her back and they found that mass in the azygoesophageal recess.
Jennings astutely pointed out that the posterior mass looked very heterogeneous and almost cystic. The films were outside films so we decided to try a bronch and a repeat CT. Our radiologists felt comfortable that the peripheral lesion looks like a hamartoma and agreed the mass appeared cystic like a bronchogenic cyst. The bronch (we tried some FNA passes. Was fairly unremarkable and essentially non-diagnostic.
Would you have done something else? Would you consider a PET? If negative we might not repeat imaging studies as frequently... Or would you even bother with scheduled CTs if she remains asymptomatic?

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

Jeff H said...

I think a PET might be useful in risk-stratification. A + PET in that new lesion might prompt a more aggressive approach, including repeat attempts to biopsy (it looks like an endoscopic ultrasound with transesphageal biopsies might be easier). At the very least, a positive PET would mandate very close follow up with imaging.

A negative PET would not be conclusive, but would be reassuring. Regardless, I would follow it with serial imaging.

The peripheral lesion does look like a hamartoma.