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Light cough persistently, shortness of breath, weight loss, lower lobe bronchus with mild left pleural effusion. Is Bronchoscopy needed?

Age: 57, Gender-F; Persistent light cough, shortness of breath (which makes it difficult to speak at times) and weight loss since Oct 2012 (from 35 kg in Oct to 31 kg in Feb). Chest X-ray in Dec 2012 reported blunting of the left costophrenic angle. CECT done a few days back; findings: • Large collapse consolidation of left lower lobe with multiple areas of breakdown and calcifications, extending into carinal region causing narrowing of left main bronchus and complete occlusion of left lower lobe bronchus with mild left pleural effusion & mediastinal lymphadenopathy. • Lobulated parenchymal opacity with irregular margins involving superior and anterior basal segments of left lower lobe, inferior lingula and posterior segment of left upper lobe inferiorly. Imaging findings suggest possibility of ? Infective/ ? mitotic etiology. PFT had values (as % of predicted) of 56% (FVC), 67% (FET1) and 114% (FET1/FVC). The pulmonologist we consulted suspects TB or CA and advises bronchoscopy and sputum test asap. Patient had surgery for Pancreatic CA in 2005. Post last experience of a major surgery and a general belief in holistic medicine, patient is extremely resistant to any treatment or even further tests. Do CECT Results suggest that it may not be CA? Or is CA definitive? And can the CECT itself suggest anything on stage of CA? What are the risks we stand if Mummy does not agree to Bronchoscopy. We are hopeful of getting Sputum test done in the next 2-3 days. If that comes +ive, will Bronchoscopy still be needed?
Asked On : Mon, 18 Feb 2013
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Internal Medicine Specialist 's  Response

I am really sorry to hear about your mother

From history , this is clear that its a kind of cancerous growth in lower lobe of the lung as its margina are irregular , next step is CECT of chest to see other small parts of this cancer in rest of the lung fields , but you cannot stage the cancer on cect , amgiguous grading can be done on cect but not helpful

This is not TB at all , i have seen so mant patients , besides TB doesnot cause collapse but do cause mediastinal lymphadenopathy

Bronchoscopy is a MUST , for biopsy and then accurate staging , grading and name of the cancer , without biopsy and name of the cancer no1 can treat

Give sedatives , like midazolam , or ketamine and your mother wont remember anything at all while broncoscopy , sputum test is also not useful even if it comes positive for caANCER CELLS , dont waste time , just do bronchoscopy , and the way i told you

Hope this helps
Answered: Thu, 29 Aug 2013
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