Tuesday, June 06, 2006

Case Study T reply

We have a reply to a case study posted.

Malignant effusion? Cardiomyopathy, perhaps from chemo?

Where was the primary (right or left)? could this be a recurrence, with post-obstructive pneumonia on the left? what was the stage of the cancer?

I'm assuming she had an echo. What did this show? if this was a large effusion, might be important to try a pericardiocentesis and send the fluid for cytology. that would have big implications on her prognosis. otherwise, chest CT, or if really suspicious, a staging CT. then again, i'm only an endocrinologist :)

What it actually turned out to be was a malignant pericardial effusion, confirmed by echocardiogram The echocardiogram showed evidence of secondary deposits in the visceral pericardium, with some masses, but only very minimal signs of tamponade. The effusion volume was probably (guesstimate 300cc) as she was only minimally symptomatic after some IV lasix, I recommended that she should go for a pericardiotomy as a more permanent solution, in view of her low platelet count following chemotherapy and her impending chemotherapy (including cisplatinum, which requires large volume infusion for rehydration). They refused urgent pericardiotomy. Personally, I felt that her longterm prognosis was poor, but the attending oncologist felt that it was good. I thought that it was Stage 4 Ca Lung (poorly differentiated).

Keep those replies to the case studies coming.

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