ACCIDENTAL DICOVERY

     In medicine we do tests  and sometimes we do tests that we expect to be negative. It is like calling someone expecting him to be not home and then leaving message , and taking credit that we did call. When someone has clot in lungs, we try to find out why . So we do the work up. The clot in lungs come from some other source - usually from leg veins  and then a small portion of the clot gets detached and then goes to lungs where it blocks the circulation and that causes the shortness of breath and other symptoms. There are reasons why a clot may form in leg veins - so called DEEP VEIN THROMBOSIS. Usually it happens due to inactivity - long distance travelblog injury  or surgery and also other causes. Immobility leads to stagnation of the circulation and that leads to clot and so this is called PROVOKED.  Then there are clots which form when we cannot see the cause. This is called UNPROVOKED clot. That brings me to the today's patient. 

    I was called to see this patient . He was 70 years old and had some cough and no shortness of breath, He had 3-4 episodes of so called Pneumonia in last few months. He had some chest pain and so he went to walk in clinic and had CT scan done and that showed a clot in the lungs  and so he was admitted. But it also showed a density in the lungs and so there was a concern as what that was. I saw him and he was also seen by hematologist. They had ordered some blood tests - this is to know if there is 'tendency to form clot' so called Hypercoagulation status . For some reason related to abnormality in blood itself which makes forming clot easier. But they also ordered CT scan of abdomen and pelvis . Now I have seen this being done many times as OCULT CANCER can present as Unprovoked Clot. I have not seen any new discovery in past many years when CT scan is done . But in this case it showed  a mass in stomach, Normally the stomach is a hollow cavity or a bag and mass in it is nit obvious on CT scan. But this time it did  and so we have him do a biopsy and that showed a type of a tumor not very common called GIST -gastro-intestinal stromal tumor. 

   So, we have a patient who had pneumonia  and CT scan showed a clot  and also a clot in leg - which is common scenario, but now we also have other abnormality in lung which could be a tumor or pneumonia or clot related  infarcted lung . But he also has a tumor in stomach. 

   We will do  follow up CT scan of lung and also PET scan and then he will need surgery to remove the stomach mass . If the lung abnormality does not clear , he will need biopsy of that too. But for now with clot and need for blood thinner we have not done any surgery or additional biopsies.