findings, and histological or cytological confirmation of intrathoracic lymph nodeinvolvement is required for patients in whom the only contraindication to potentiallycurative surgery is lymph node enlargement.
A 65-year-old man who has a 40-pack year history of smoking is referred tothe clinic with haemoptysis. He has no other symptoms. His chest radiographshows an ill-defined 2-cm opacity at the periphery of his left lower lobe. Afterchecking his routine blood tests and spirometry in clinic, which test would youarrange next?Bronchoscopy
CT scan of the chest
Repeat chest radiograph in 1 month from now
Lung cancer is the most likely diagnosis in this man. A CT scan is the best test toperform initially to locate, characterise and stage the lesion if it is cancer.Histological confirmation would then be sought, with either a bronchoscopy if the lesion is proximal or a CT or ultrasound-guided biopsy if it is peripheral. Apositron-emission tomography (PET) scan would determine whether there aredistant metastases and is performed after the CT. Sputum cytology can be usedto provide a histological diagnosis, but a tissue biopsy is favoured by thepathologists. Pneumonia can cause haemoptysis and chest radiographabnormalities, but it can also be associated with a proximal carcinoma. Youshould have a low threshold for performing a CT scan initially in a high-riskpatient.
A 17-year-old boy has been complaining of shortness of breath for the last 2days. On examination bronchial breathing is heard over the right lower lobe.What is the most likely diagnosis for this clinical finding?Pneumothorax