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Done chemotherapy for pulmonary carcinoid. Coughing clear phlegm, painful. Is this common?

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Pulmonologist
Practicing since : 2003
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My husband had a pneumenectomy for a pulminary carcinoid May 1st. He has since had chemotherapy (just finished last round last week) because it has come up positive in his lymphatic system. We have asked the oncologist repeatedly about a chronic couch in which he vomits up clear phlegm several times a day. It is so painful that his side is still hurting. It is in the morning/noon/night that this occurs and he has been prescribed cough meds (hydrocodone in it). It does help for a short time but the phlegm is alot. Is this common and will this be a chronic condition that will eventually get better? Thanks.
Posted Tue, 25 Sep 2012 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 5 hours later
Hi,
Thanks for posting the query on XXXXXXX
After going through your query, I would like to comment the following:

1. Your husband had a pneumonectomy for carcinoid in May 2012.

2. After pneumonectomy now there is a complaint of cough with expectoration.

3. Post pneumonectomy, the cause of his cough could be
a.Post pneumonectomy broncho pleural fistula.- In this the cough is aggravated when the patient lies on the opposite side. On chest xray a air fluid level will be seen. This condition requires the closure of the fistula either surgically or through bronchoscopy.
b. Secondary respiratory infection- fever may be accompanied with cough here. The chest xray may show some consolidation/ infective process in the normal lung. A course of antibiotics is indicated here.
c. Associated other condition like obstructive airway disease- especially if he is a smoker. Pulmonary function tests, smoking cessation and bronchodilators are indicated here.

4. I would suggest, you visit a Pulmonologist and get your husband clinically evaluated and investigated as advised above.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Done chemotherapy for pulmonary carcinoid. Coughing clear phlegm, painful. Is this common? 10 hours later
He had a CT scan last week, which showed - Surgical change right pneumonectomy with pleural fluid occupying the small right hemithorax. Shift of the heart and mediastinum toward the right side is noted as well as No pericardial effusion or pleural fluid on the left side is noted, heart size is normal and a moderate large hiatal hernia is noted - He is not a smoker, and was first diagnosed with carcinoid 7 years ago. At that time he received a lobectomy for the right lung and because of reoccurence, a pnneumonectomy was required. Would that fluid be causing a chronic cough in your opinion? I will be calling his thoracic surgeon today and ask, because soon after surgery an x-ray was done and the surgeon did not see a post pneumonectomy broncho pleural fistula.
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for the follow up.

Normally the presence of a small amount of fluid after pneumonectomy provides stability to the thorax.
Sometimes due to secondary infection at the bronchial stump a broncho pleural fistula may be be formed at a later stage causing cough but this cough is postural in nature and increases on lying on the normal lung side.
I would suggest you go ahead with the clinical evaluation with the thoracic surgeon but also please consult a Pulmonologist for detailed evaluation of cough.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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