Lung cancer Power Point

Chest Case #6

69 yr old wf with pmhx notable for hypothyroidism and COPD presents with 3 month hx of persistent dry cough accompanied by right sided chest pain with deep inspiration, increasing exercise intolerance and 30 lb unintentional weight loss. Pt denies previous similar episodes. She has a 50 pk/yr hx of tobacco use.

History and PhysicalT 97.7 P 86 BP

140/84 O2 97% RR 18

Gen: Thin, nadCV: RRR, well-

perfused cr < 3 secPulm: Lungs CTA

bilatAbd: s/nt/nd

Chest X-Ray

Diagnosis: Lung Cancer

Note right upper lobe neoplasm easily visible on both ap and lateral films.

Medical therapyRespiratory support / volume resuscitation as

needed Dispo.

If patient is vitally stable without oxygen requirement – discharge home with arranged follow up for biopsy/further evaluation is appropriate.

If clinically unstable or reasonable outpatient follow up cannot be arranged patient should be admitted for inpatient stabilization/ initiation of workup.

ED Management

Presentation Often vague diffuse complaints – dry cough, weight loss,

hemoptysis, malaise, fevers/chills, nausea, chest pain, etc. CXR patterns

Adenocarcinoma – (35-50%) Peripheral, sometimes associated with scars, high incidence of early metastasis

Squamous Cell Carcinoma – (30%) Central, with hilar involvement, cavitation is common, slow growing

Small Cell - (15-20%) Central, cavitation is rare, hilar and mediastinal masses often the dominant feature, rapid growth and early metastases

Large cell – (10-15%) Peripheral, large, cavitation present Bronchaveolar – (3%) Peripheral, rounded appearance,

pneumonia-like infiltrate (air bronchograms), occasionally multifocal Carcinoid – (less than 1%) Typically a well defined endobronchial

lesion; nodal, liver and brain metastases may enhance densely (i.e. They may be hypervascular)

Pearls

Additional Images: Lung Cancer