Friday, April 13, 2007

Cavitary mass

86 year old man with history of dementia brought by his caretaker for mental status changes and lethargy. He lives in an assisted living facility, but has no TB risk factors otherwise (He has his own apartment-like structure, but I beleive there is a common area).

His CT:

There was no hilar or mediastinal adenopathy.
The thickest wall area on that lesion was 4-5 mm.

Someone placed a PPD and it was 11 mm. It was reportedly negative 6 months ago.
He is not productive of sputum, so 3 gastric lavages were done and they were all negative. What would you do next? Are you worried about active tb? Here are my thoughts
1. How sensitive is gastric lavage for afb?
2. location of the cavitary mass is not where tb should be.
3. is he a ppd converter, or was he anergic or are we seeing a booster effect
4. His family does not want an aggressive w/u for cancer, but on the other hand one would not want to send someone home to hospice with active tb....

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

Anonymous said...

Most likely diagnosis is recurrent aspiration. Esophagus is dilated on CT.
Would do swall eval/swallogram and bronch to rule out actino, etc.

Anonymous said...

How about checking quantiferon gold test!

Anonymous said...

Does he have teeth and how do they look like. I will treat for lung abscess as look multiple cavities.