DI-Chest-lung Nodule

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.
Figure B.
Figure C.
Figure D.
Small noncalcified
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. __________________