Tuesday, May 30, 2006

Lung nodules

We are back from ATS and will start posting new cases.
This is a 60 y/o woman with a significant previous TOB Hx with very little on the way of symptoms. She had some cough and a CxR revealed a small nodule on the R. The CT scan below actually revealed two nodules, one on each side (see below, they are both fairly small). How concerned would you be and how would you work her up?

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

Arenberg said...

I'd be very concerned, as they both have at least a 50-50 chance of being cancer. I'd get PFT's and a PET scan to rule out distant disease. If you want to give someone like this the benefit of the doubt, you'd treat her as if she had two T1 lesions (assuming the PET was not indicative of metastatic disease outside the lungs). Most surgeon's would probably want at least one of these to light up on PET, then take it out. After that you probably biopsy the other one, or just take it out in a diagnostic staged thoracoscopic procedure followed by a lobectomy if she could tolerate it.

The one guy we did this for recently in our tumor board had a fatal MI in the period between his first thoracotomy, and the planned second one.

Jeff H said...

Yea. What he said. I'd be very concerned.

james gaulte said...

I would be concerned as well and agree with getting a PET.Any chance of obtaining old cxrs,sometimes there are the very best diagnostic procedure.

Baleeiro said...

I was concerned too. She did not know of old CxRays and had never been told about nodules before.
I will post on the workup tomorrow in case there are any other suggestions.