Monday, July 10, 2006

Lesion and hemoptysis.

Here is a question received from the case submission form:

Patient is a 66 years old Male, Smoker since last 30 years. Hypertensive too ( IInd class)
Presently, C/O an edpisode of Haemoptysis in June 2006. Lasted for 1 and 1/2 days.

A similar episode of Haemoptysis occured in year 2002. The HRCT report at that time indicated : Small (.8cm) pre-tracheal,Right para tracheal sub-carnial lymph node. The patient was subsequently diagonsed with RENAL Stenosis and a stunt was placed without incident.

Data: Chest xray showed a small patch of moderately dense,streaky opacity at left base with localized loss of definition of cardiac apex

MRI findings : 1. Fibre lesion in right middle lobe. 2. No evidence of pleural effusion/thickening. 3.Small sub-centrimeter, pre tracheal, right para tracheal sub carnial lymphnodes. However, no evidence of significant mediastinal lymphadenopathy.

FOB + Biopsy : Bronchial mucosa shows foci of inflammatory cells in the stroma and focal area of squamous metaplasia.

Question: Is it Lung cancer : Stage 1? If not, appreciate if you can guide us further.

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

Baleeiro said...

I would consider that a non-diagnostic (rather than negative) bronch and would go after more tissue. What is the size of the right middle lobe lesion? A PET scan may assist in choosing the re-Bx site (mediastinoscopy vs. CT-guided FNA).

Arenberg said...

This sounds fishy tome. I too want to know the size of the "lesion" in the RML, and was this really an MRI (if so why MRI and not a chest CT?). The lymph nodes may or may not be important, but first you need to know how big the nodule is, was it present on old films, is it calcified etc.,

Standard bronchoscopy currently has little or no role to play in the evaluation of a small peripheral lung nodule.

Anonymous said...

since the lesion is only 0.8cm and he only had 2 episodes of hemoptysis in 4 years...i seriously doubt this is cancer...since the nodule is only 0.8cm a pet scan might not be too his pft good enough for surgery(vats if its peripheral)..this might be a granuloma or hamartoma

Jennings said...

The squamous metaplasia does not necessarily imply cancer; it is also in line with an inflammatory process, which was seen in the stroma of mucosal biopsy. I would consider following these findings with serial CT's (every 3 months) to assess for change in size. I would not intervene unless there is growth of these nodules.

Mendez said...

I'm assuming AFB was checked on BAL. If not, PPD?