We in medicine are many a times sure on our thinking and diagnosis. Again this is based on our education and experience and statistics. As I have mentioned in my previous blogs , the entire medicine is based on statistics. If I see someone with cough and fever and yellow sputum, I would diagnose as having bronchitis or pneumonia if on physical examination there are abnormality. We are correct in our thought process and diagnosis and planned treatment. We don't do the sputum culture to start antibiotics or which one to give. Again this is based on statistics. But sometimes we are wrong . and then we say or thin this is one in a million. That brings me to the story for today .
I have known this 90 years old male for last 90 years or so. He had mild lung problem like asthma and he had been on inhalers and was quite stable. One day I got a call from his physician that he did a CT SCAN and he has cancer. I was shocked . He was 90 years old and he had not smoked for more than 30 years ago I had seen him 3 weeks ago and he was stable. His last chest x- ray done 15 months ago was OK . So I was surprised . But the CT scan had shown a mass and that definitely looked like cancer. I told my office to call him and set him up for PET scan and biopsy. My office called the patient to set it up . He had a grand daughter and we had to call her . But then I got a call from her and she told me that he had a fall and he was taken to ER and then was admitted .They were doing work up to make sure he did not have bleeding or stroke. The work up was ok and he was still littlle confused . He was in the hospital where I do not go. But the granddaughter wanted me to check the chart and make sure that what they were doing was OK with me. The lung specialist planned to do the biopsy like I had planned and he did . There was narrowing and there was some susicion of cancer but then when he checked the pus came out from that area . I continued to check and he had infection and no cancer was detected on biopsy. He was started on antibiotics and he was discharged on IV antibiotics
I spoke to them on telephone as he was too weak and could not come to office. Hew as doing better and last chest X- ray was much better. So it looks like he did not have cancer but had lung abscess - infection and pus in lung that looked like cancer.
This kind of thing does not happen often but only one in million .
