I am in medical practice for many years and feel that 'i have seen this movie before,' many a times . But every now and then , we come across a case where something new is seen and that stuns me..
I saw this patient who had cough and some fever . He had not smoked for many years but had been admitted to hospital with pneumonia more than 6 months ago. I had no old records, but when he saw me his Primary care doctor had done chest x- ray and that had shown pneumonia and so he was treated with antibiotics and was sent to me. I looked at old reports and hospital records. He was admitted with cough , fever and then was admitted and then the chest x- ray had shown pneumonia - in the same place as it was seen now - upper part of the lung. I looked at the old CT scan chest done few months ago. He had pneumonia and looked like he had obstruction of the bronchus going to that lobe - segment of the lung - the same upper lobe , that he had pneumonia now. I was now worried and may be convinced that he had a tumor in the upper lobe bronchus , and that had blocked the bronchus , and that had caused recurrent infection and HE MAY HAVE CANCER.
I explained him as to what I was concerned about. We ordered new scans and also the PET scan . As I have stated in many blogs , the Pet scan is done to see glucose uptake in abnormal areas and usually the uptake of the glucose is high when there is cancer or infection. I also decided to do Bronchoscopy. The Pet scan was done and that showed only mild uptake . So it may have been a blocked bronchus with only pneumonia.
The bronchoscopy was done and I saw a blocking mass that was occluding the opening of the bronchus. As I looked at that carefully to consider biopsy, I realized that it was very hard . There was no way I could biopsy as it was not a soft - friable cancer, but was a STONE -HARD STONE that was blocking the bronchus. It was a broncholith or a stone in the bronchus. There was no way I could biopsy it or remove it as it was embedded deep.
I sent him to a chest surgeon , but he did ot want surgery. .
