DECEPTION

      In medicine we have a trust in certain things . I f often say ,'if this is normal then that is not likely or not possible. And then we come across a case or 2 ,that proves us wrong. If  fasting sugar is 100 mg or less then you don't have diabetes , or if one is not a smoker ,then chance of having lung cancer is very low . The statements are true from statistical stand point.  This brings me to the story for today. 

  I had seen this patient many years ago . She was 70 years old female , who had been smoker and had smoking related lung disease -COPD. She also had a smaa nodule and that was stable for 2 years . So she was lost for follow up. I think she thought that she had stable nodules for 2 years and so it was less likely tat that was cancer and she had continued to smoke . She saw me again after a gap of 5 years. She had been  to hospital for various things including shortness of breath. She had continued to smoke . She had some cough and also no fever, weight loss  and no new CT scan of chest . She had couple of chest x- rays done and they had shown no nodule on right side but had shown some congestion and small fluid on left side in the lower part. 

    I ordered breathing test and a CT scan chest . She was again admitted and I was not consulted or informed and she had suspected stroke and that was cleared . she was discharged and then again readmitted with some cough and some shortness of breath. This time I was called in . She had a CT scan of the chest to rule out clot in the lungs  and the CT scan did not show any clot ,but showed a MASS in the left upper part of the lung which was compressing the bronchus and blood vessle going to left upper lobe of the lung . She also had mass lower down and also on right side next to the center of the lung and also there was another nodule or mass in right lower lobe. This was increased from the CT scan that was done 5 years ago. So here is a lady that had 2-3 chest x- rays of the chest which did not show any mass , but some congestion and some fluid on left LOWER part, now has masses in left upper lobe , left center , rt center and right lower lobe . NONE OF THIS WAS SEEN ON PLAIN CHEST X- RAY . 

     In all probability this is cancer But how much we rely on plain x- ray and now the CT scan showed so many things that were NOT EVEN SUSPECTED by looking at the chest x- ray. This is what I called deception.