RADIOLOGY CASE REPORT



RADIOLOGY CASE REPORT

Patient ID: OH# 24459331 Date of Study: March 10, 2008

Type of Study: CR Chest, 2 Views (PA & Lat)

1. Clinical Indication:

Pre-operative study: right upper lobe lung cancer

60 year old man who presented with dyspnea and cough in August 2007. A lesion was first discovered in the right upper lobe on x-ray at that time. He has since had further assessment done and has been treated with chemotherapy for non-small cell lung cancer.

2. Picture:

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Previous study (Nov 2007):

[pic]

2. Describe the radiological findings:

There is a mass in the posterior aspect of the right upper lobe. A significant decrease in size is noted when compared to the previous study done in November 2007. There are no other nodules or masses. The left lung field, mediastinum, hila and heart are normal. There is no evident lymphadenopathy seen in the mediastinum and no pleural effusions are seen.

3. Provide possible diagnosis(es):

Malignant lesions

Bronchogenic carcinoma (small cell, large cell, adenocarcinoma, and squamous)

Carcinoids

Solitary metastasis

Benign lesions

Benign neoplasm (hamartoma, lipoma, and fibroma)

Vascular lesion (AVM)

Infectious granuloma - Tuberculosis, atypical mycobacterial infection, histoplasmosis, coccidioidomycosis, and blastomycosis

Other infection - Aspergilloma, ascaris, dirofilariasis, echinococcal cyst, and bacterial abscess

Noninfectious granuloma - Rheumatoid arthritis, Wegener granulomatosis, and sarcoidosis

Developmental lesion - Bronchogenic cyst

Other condition - Hematoma, bronchiolitis obliterans-organizing pneumonia, pseudotumor, pulmonary infarction, amyloidoma, rounded atelectasis, and mucoid impaction

4. What would you recommend next for this patient?

This patient requires further imagining of the thorax, preferentially by CT scan, as well as a needle biopsy under fluoroscopic guidance and consultation with thoracic surgeon. In this specific case, these studies and the consultation have already been done, and the patient is scheduled to undergo a bronchoscopy, right thoracotomy and right upper lobectomy. The patient will also require follow-up imagine post-surgery.

5. Is the use of this test/procedure appropriate?

Yes, the use of this test is appropriate for this patient.

6. Is (are) there any alternate test(s)?

Alternate tests in clued CT scan and MRI.

7. How would you explain to the patient about the possible risks and benefits of this test?

A chest radiograph provides 0.1 mSv of radiation, which is the equivalent to 10 days of normal or background radiation exposure. This amount of radiation exposure is much less than a CT scan. Women who may be pregnant should avoid radiography in most cases. The benefits of radiography in this case are that the x-ray can give us information about his cancer’s response to treatment and provide important information to the surgeon who will be operating. Radiation does not remain in the body once the exam is completed and the procedure is painless and takes only a few minutes to complete.

8. What is the cost of this test?

The cost of two views of the chest is currently $33.50 in Ontario.



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