Just curious on Consensus:
79 year old no respiratory symtpoms.
CT from August 2004 showed some hilar and paratracheal nodes. They have been followed.
CT from this month shows:
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Abnormal anterior mediastinal soft tissue and enlarged right paratracheal, AP window, and bilateral hilar lymph nodes are unchanged from June 2005. Some of the lymph nodes have enlarged since August 2004, although the right paratracheal lymph nodes and hilar lymph nodes are stable. The anterior mediastinal soft tissue is new since 26 August 2004.
Multiple bilateral tiny lung opacities are unchanged from August 2004. However, an 8 mm lesion adjacent to the anterior segment bronchus of the right upper lobe on image 45/133 has enlarged since August 2004.
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Would anyone proceed to tissue biopsy in this 79 year old asymptomatic man, or just keep following, even though some of the nodes have enlarged?
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I think the concerning aspect is the new anterior mediastinal mass. With the enlarging nodes, an anterior mediastinal mass could easily be a low grade lymphoma. Unless I'm missing something here, I would recommend a biopsy.
I agree with JCH that there are some slow growing tumors that could well fit this case.
I also think this goes back to some previous posts on what to do with old(er) folks with potentially bad diseases (http://pulmonaryroundtable.blogspot.com/2005/12/another-80-year-old-with-lung-lesion.html). He is 79 and seems to have a slow-growing lesion... does he want a diagnosis? Would he want or be able to tolerate chemo if needed? He may have a low-grade, low-stage NHL and have decent prognosis if treated...
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