tag:blogger.com,1999:blog-12660458.post112975765014022144..comments2023-09-01T10:33:09.297-04:00Comments on Pulmonary Roundtable: More pulmonary nodulesUnknownnoreply@blogger.comBlogger2125tag:blogger.com,1999:blog-12660458.post-1129822395977951852005-10-20T11:33:00.000-04:002005-10-20T11:33:00.000-04:00I love the fact that we are clustering cases. It r...I love the fact that we are clustering cases. It really solidifies my understanding of a process if I see several cases with both subtle and not-so-subtle differences.<BR/>JCH's differential is excellent. <BR/>1. How large are these nodules (i.e. will a negative PET be sensitive enough for us).<BR/>2. If DA reads this case, how di you proceed in these cases before the PET scan?Mike Lhttps://www.blogger.com/profile/12177750268091750583noreply@blogger.comtag:blogger.com,1999:blog-12660458.post-1129810723262846962005-10-20T08:18:00.000-04:002005-10-20T08:18:00.000-04:00I'll start with this: the likelihood of lung cance...I'll start with this: the likelihood of lung cancer in a 40 year old, asymptomatic woman is low to begin with. Then, we add that she has bilateral nodules-so that if these are lung cancer, she has either Stage 4 metastatic disease or synchronous primaries. Each is possible, but unlikely.<BR/><BR/>Could these be metastatic? I'd consider ovarian, less likley breast, possibly germ-cell, lymphoma. Again, I think these are unlikely.<BR/><BR/>Infectious causes? Possibly endemic fungi and they just havn't calcified yet. Without any symptoms, I think that infections/inflammatory lesions are unlikely.<BR/><BR/>AVM? Hamartoma? These don't have the classic look.<BR/><BR/>Autoimmune (i.e. Wegeners)-again, seem less likely without any associated symptoms.<BR/><BR/>All that said, these aren't the 3mm ditzels so commonly seen today. I think that, as I'm favor a benign lesion here, I'd start with a PET and some screening serologies (ANCA). If all are negative, I'd follow radiagraphically. If the PET is positive, it would get more complicated and depend on whether one or both of these are hot and if there is anything that is extra-thoracic.Jeff Hhttps://www.blogger.com/profile/01209432708535732499noreply@blogger.com