Thursday, July 27, 2006

mediastinal nodes

Case submitted from outside:

63 year old smoker with hypoxia. CXR looks extremely hyperinflated. PFTs with ratio of 0.67, FEV1 87% predicted and FVC 93%. Lung volumes normal except for an inspiratory capacity of 73% predicted (volume done by helium dilution). DLCO 35% predicted. CT scans included below and are basically unchanged from 7 months ago. Mild mediastinal LAD, with the largest being approx 2cm. Also stable over 7 months. Would anyone pursue a biopsy of the nodes or the lung? Other thoughts?

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

Arenberg said...

Hi Jeff, nice pictures...I don't feel like a LN bx would be that helpful here if they were stable for that long.

The CT looks like early ILD, and that might explain everything from the low DLCO (with preserved volumes because of concommittant emphysema), to the presence of enlarged lymph nodes (commonly seen in ILD). Whaddya think? Any rales on exam?

I blog...therefore I am. (Socrates)

AK said...

Fine basilar crackles on exam. I thought this was emphysema with either IPF or RB-ILD and was more inclined to watch. He feels a lot better on Spiriva and just quit smoking.