RADIOLOGY CASE REPORT



RADIOLOGY CASE REPORT

Patient ID: OH#_____02382497_____ Date of Study: ______20-Aug-08_______

Type of Study: ____CT Thorax enhanced___________________________________

1. Clinical Indication: __76 year old male, smoker, left upper lobe nodule seen on previous chest radiograph. ______________________________________________

2. Picture:

Figure A.

[pic]

Figure B.

[pic]

Figure C.

[pic]

Figure D.

[pic]

2. Describe the radiological findings:

_____There are two small, spiculated, nodules, one measuring approximately 2 cm by 1.3 cm and located in the right middle lobe [Figure A], and another slightly smaller in size in the left upper lobe [Figure B]. Additionally there is a small, smooth non-calcified lesion measuring less than 5 mm in keeping with a granuloma [Figure D] and there are multiple bullae throughout both lung fields [example – Figure C]. There is a single lytic lesion in the thoracic vertebrae consistent with a bony metastasis, as well as significant hypoattenuated regions of the liver [Not shown]. The hila is unremarkable. There are no soft tissue abnormalities. There is no significant pleural effusion seen._________

3. Provide possible diagnosis(es):

________Chronic obstructive pulmonary disease, primary lung cancer, benign neoplasm, lung metastases, sarcoidosis, tuberculosis.__________

4. What would you recommend next for this patient?

_______I would recommend a transthoracic fine needle aspiration of the right middle lobe nodule as it would be easily achieved with fluoroscopy.__________

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

____Yes, this patient is at high risk for lung cancer with a history of smoking and new lesion found on chest radiograph. A CT scan was indicated to further characterize the lesion, and for diagnostic planning.________

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

______A bronchcoscopy could have been done, but given the location of the nodules on the periphery of the lung fields, CT was a better choice. Additionally CT imaging can help to access staging by looking at hilar lymph nodes._______

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

_____I would tell the patient that they will be exposed to radiation, but given the high necessity of this test to diagnose a possible life-threatening problem, the advantage gained of doing so outweighs the risk. The amount of radiation received from a CT thorax is less likely to cause further cancer than continuing to smoke cigarettes. Another minor risk is the contrast dye. It may cause an allergic reaction. I would reassure the patient that they are in a controlled environment and should this occur they will be taken care of appropriately. Contrast dye is also eliminated through the kidneys, therefore, if the patient has pre-existing kidney disease, they are at risk of further damage and therefore I would tell them they require a blood test (creatinine) beforehand and may need to drink plenty of fluids to minimize this risk.________

8. What is the cost of this test?

_____It costs approximately $75.00 for reading of a CT thorax. __________________

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Nodule

Nodule

Bulla

Small non-calcified granuloma

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