How would you (or would you) work up this lesion?
Monday, December 05, 2005
Abnormal CT scan
This is a 44 y/o man referred to our office because of an abnormal CT scan of the chest. He had fallen of a horse and had a CT scan of his thoracic spine and the mediastinal findings were incidental. He has NO respiratory symptoms. He is a smoker (1-1.5 pack/day x ~30years) and has normal PFTs. I have outlined the abnormality on the first cut so you may follow along. No other parenchymal abnormalities were noted.
How would you (or would you) work up this lesion?
How would you (or would you) work up this lesion?
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3 comments - CLICK HERE to read & add your own!:
He is from Tennessee, which is also histo country. You are right on the other calcified node. No known TB exposure and he has no respiratory symptoms.
I agree with a PET now, and biopsy if it is +, follow-up radiographs if negative.
I'm not sure, however, that a mediastinoscopy can access that pre-vascular region...
I am not so sure a negative PET scan would be very helpful to me. It could be a lymphoma in the prevascular lymph nodes and be PET negative. Also, slow growing lymphomas are notorious for being "stable" for 2 years on CT scan.
I would send him to thoracic surgery for a biopsy.
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