Lung - Need Help to Clarify Approp Steps

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Lung - Need Help to Clarify Approp Steps

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doyoudig
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05/13/07 - 05:09 PM

Pt comes in w/ Cough Bloody Sputum
1. Is ur Initial Step CXR?

1.a if CXR is negative what next? -- CT w/ contrast or Spiral CT??

2. What if CT is negative ???, what is next then??

2. If CXR is positive n shows a
--> peripheral Lesion, what the next Step (CT then FNA??)
--> Central lesion, what the next step (Sptum cytology, then flexible or rigid bronchoscopy??)

Justice
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05/13/07 - 07:11 PM

I think CXR goes first
Depending upon results - single peribronchial shadow (central cancer) or multiple perif lesions (Wagener’s) you decide if you do bronchoscopy or chest CT, probably spiral as no contrast is needed for identification of parenchymal lesions
Bronchoscopy will also be indicated if you see nothing on CXR and spCT – the Pt may have bleeding from laryngeal/bronchial papillomas
More ideas are welcome
grin

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doyoudig
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05/13/07 - 09:14 PM

ok si ur saying CXR Initially, if negative Spiral CT if peripheral n bronchoscopy is central??

Justice
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05/13/07 - 09:41 PM

doyoudig wrote:
ok si ur saying CXR Initially, if negative Spiral CT if peripheral n bronchoscopy is central??

Yes, CXR is first
if negative - do bronchoscopy
if positive central - do bronchoscopy (attempt biopsy) and then CT to stage;
if positive on periphery - do CT and CT-guided FNB

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doyoudig
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05/14/07 - 09:19 AM

Thank You

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