RADIOLOGY CASE REPORT



RADIOLOGY CASE REPORT

Friday July 4, 2008

Patient ID: OH# 03538402 Date of Study: May 21, 2008

Type of Study: CHEST PA & LATERAL X-ray

1. Clinical Indication: 85 year old female with nonsmall cell lung cancer and

SVC syndrome with recent increased SOB and decreased air entry at lung

bases.

2. Picture: CHEST PA & LATERAL X-ray

[pic]

For interest, I have included a CT thorax C+ image showing the size of the SVC obstruction from Feb 26/08:

[pic]

2. Describe the radiological findings:

Chest X-ray: There are small, bilateral pleural effusions (meniscal sign, loss of costophrenic angles) with basilar atelectasis (consolidation/silhouette sign with volume loss/hyperinflation) more on the left. There is also widening of the mediastinum. The lungs are otherwise unremarkable.

3. Provide possible diagnosis(es):

Differential Diagnosis of a Middle Mediastinal Mass:

o Metastatic disease (eg non-small cell lung cancer)

o Lymphadenopathy (cancer spread, infection, sarcoidosis)

o Bronchogenic cyst

o Vascular (aorta, SVC)

o Esophageal tumour

o Tracheal tumour

4. What would you recommend next for this patient?

Initial management:

o ABCs: Ensure patient’s oxygen saturation is >90% with supplemental oxygen.

Secondary management:

o CT Scan to follow mediastinal mass and full metastatic workup.

o Radiation therapy to help manage SVC obstruction and sequelae of this disease.

o Pain management: as for palliative care protocol.

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

Yes, a chest X-ray and CT scan to diagnose & follow a patient with SVC obstruction are appropriate in this case.

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

A biopsy (eg FNAB) of the mediastinal mass is necessary to stage the cancer and to guide management. Staging will also provide a prognosis for this patient.

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

The risks of X-ray and CT scan are primarily the exposure to radiation. Lifetime risk of developing fatal cancer from radiation exposure in a population is 0.005% per milliSievert (mSv). A Chest X-ray (single PA film) exposes the patient to an equivalent of approximately 3 days of normal background radiation. A CT of the chest exposes the patient to an equivalent of approximately 3.6 years of background radiation (~2.2 mSv/year). NB: Pregnancy is a contraindication to both X-ray and CT. The risk of CT with contrast is primarily the toxicity to the contrast media (eg renal disease)

The obvious benefit of diagnostic imaging is the ability to diagnose and guide management of ill patients. The advantage of CT over plain films is the ability to delineate soft tissues.

8. What is the cost of this test?

When searching the WWW, I found the quote for the cost of a chest X-ray to vary from $23 in Quebec to $200 in California.

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