His syncope was probably related to orthostasis (frankly orthostatic on presentation).
On hospital day #2, he complained of abd pain. A CT of the abd showed bilateral pulmonary nodules. A corresponding CT of the chest (cuts below) showed multiple small pulmonary nodules.
He is a lifetime non-smoker.
His colon cancer was "cured" with surgery; an exploratory lapartomy 10 years ago for a PSBO showed adhesions but o/w was normal. A colonoscopy 1 year ago was completely normal.
No other important findings
CT scan:
Now what?
Answer below.
4 comments - CLICK HERE to read & add your own!:
I agree with some of Doug's waffling. I have a very similar casde, Mike: 84 y/o non-smoker, previously "cured" colon Ca. He presented with multiple nodules and we tried a CT-guided Bx since they were all peripheral. He opted for conservative f/up and didn't want chemo or Xrt. I have been monitoring him since 11/04 and the nodules have started to grow and some are clear large masses now but he has been happy with his choice and has just come back from a trip to Florida and is planning another one...
Just to close out this case, as no one seems to want to engage further (or even in the beginning)...
A CT guided biopsy of these lesions was performed. It yielded Squamous cell CA.
To me, the learning point was how to proceed with this diagnosis.
Oncology wanted a "triple endoscopy" (i.e. Laryngoscopy, EGD and bronch). The first two were negative.
Although happy to do the bronch, the primary attending felt that it would not add anything. Oncology admitted that they would treat for lung cancer as the primary anyway, so it did not make clinical sense to do an airway exam. He had no evidence of an endobroncial lesion (atelectasis, visualized lesion in a proximal bronchus, etc).
Mike, to me the interesting question was not so much the DDx (looked like mets) but whether to put this 86 y/o through chemo for stage IV disease (of either primary site). Is he symptomatic with the nodules?
I am a 53 yr old male with multile bilateral pulmonary nodules with a hx of smoking for over 40 yrs.
9 biopsies were all inconclusive. My pulmonoligist says it is not cancer and that I should not be worried. The nodules are slowly growing and new ones are spotted at the rate of 3 or 4 per year. My father died of lung cancer. Should I seek a second opinion? Brha99@aol.com
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