Tuesday, August 08, 2006

Mass and infiltrates

This is a 59 y/o woman with a funny presentation: she had an episode of syncope at home, hit her head and had a skin lac requiring 7 stitches. While being worked up in the ER they found her to be hypotensive and febrile with an abnormal CxR and CT of the chest. She had MSSA in her sputum and the dense "mass" seen on the left images. I bronch'ed her and got "organizing pneumonia" but no malignancy. She got ABTx and the "mass" went away completely.
She has felt better and has good PFTs. However, it has now been 3 months and the peripheral faint patchy areas of reticular disease remain there and unchanged.
She has only minimal DOE. She quit smoking in 1988 and has no unusual exposures.
How would you pursue this little infiltrates? (they are present in the lower lobes as well).

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

Jennings said...

Well this is/was either infectious or COP (BOOP). With good PFT's and asymptomatic I would just observe. If she becomes symptomatic or her pulmonary function declines, I would bronch to r/o infection and if negative give a course of steroids.

Arenberg said...

Put me down for a repeat bronch and/or an open lung biopsy. If it was "BOOP" I would expect some evolution (either or better or worse) in the ground glass opacities.

I am one of theose guys with a hammer so everything looks like a nail to me, but I am still worried about BAC.