Saturday, March 27, 2021


    We often say that if it walks like duck  and quacks like duck it is duck . But sometimes we have situations where our conclusion based on our experience is not right. We have seen this many a times where ordinary people, politicians and news media tell a story and then draw a conclusion and that tends to obvious -but on further investigations the conclusion drawn based on experience is proved to be wrong. The same thing happens in medicine  and that is my story for today. 

    I was seeing this patient for sleep apnea and may be mild asthma . He was obese and over period of few years of follow up he had mot lost any weight and had continued to be obese  and was using the PAP therapy and had no problem with it . He usually had no other complaints  and the asthma part was minimal and he used to use inhalers as needed. Then one day he came to see me . He had cough and shortness of breath and it all started 6 weeks before he saw me . He was seen by his family doctor  and was given antibiotics and some cough syrup . He did not improve and so was given steroids  and different antibiotics. He continued to have problem with cough and some shortness of breath. I saw him in office and he has low normal oxygen and he had bronchospasm and wheezes . I ordered a chest X-m ray and also started him on 2 different inhalers and also different dose course of steroids. I asked him to see me in 2 weeks . The X- ray came back showing a fluid accumulation. I called him  and ordered CT scan  and asked him as to how he was feeling . He was little better as far as wheezing was concerned and he had no fever . His shortness of breath was still there but was better. The CT scan was done and the findings surprised me. He had fluid around his lung  and also a spot on the lung. I called him and told him that we will have to do the work  and that may involve number of procedures and biopsy  and also may need additional consultations . I was concerned about cancer and the presence of fluid may be due to cancer and then he would not be early of surgically resectable cancer . So I admitted him and did drain the fluid  and the fluid was somewhat  locculated -had some different pockets  and the fluid did not show cancer . So we did PET scan and I did bronchoscopy  and there was no tumor . The PET scan which is suppose to pick up cancer in almost 85% of the cases did show that the nodule had some activity and so possibility of cancer was there . So we decided to do needle biopsy of the nodule. The only other option was to ask a chest surgeon to do biopsy under anesthesia . The needle biopsy was done  and it showed inflammation  and o cancer . 

  So  the tests that I di to prove a cancer - it certainly looked like that - was not correct  and it looks like he may have had pneumonia and that caused the fluid  and he does not have cancer .. We have plans for doing follow up on chest X- ray and CT scans in future  and then we will know , but for now it looks like not a cancer . 

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