RADIOLOGY CASE REPORT

Patient ID: OH#____3677526 ______Date of Study: _____See below______

Type of Study: ____Chest x-ray______

Clinical Indication: History of colon cancer, rule out metastatic disease.

Clinical History:

60 year old female presents to the ED with a 2 week history of chest pain, increased work of breathing, and fever in July 2006. Patient has a history of rectal cancer. Chest x-ray ordered to rule out pneumonia and metastatic disease.

Images from July 2006

Radiology report from July 2006:

·  The lung parenchyma demonstrates no focal consolidation or dominant masses.

·  The cardiac silhouette is unremarkable.

·  No pleural effusion seen.

·  No focal destructive bone lesions are identified.

·  No evidence of metastatic disease

Clinical history (continued):

Patient presents to the ED in March 2009 with similar symptoms. Chest x-ray is ordered to rule out metastatic disease.

Images from March 2009

Radiology report:

·  The images are compared to a previous student in April 2008.

·  There is a slightly lobulated nodular density measuring approximately 12 x 14 mm seen currently in the right midlung zone lateral to the hilum.

·  This is very suspicious for lung metastasis.

·  An additional density is noted in the left perihilar region which appears more prominent than on previous study.

Clinical history (continued):

In July 2009, the patient undergoes a right pneumonectomy.

Images from July 2009

Radiology report:

Right-sided hydropneumothorax continues to be the same.

Questions to be answered:

  1. Provide possible diagnosis(es): most likely metastatic disease from previous rectal cancer.
  2. What would you recommend next for this patient? Resection of the cancer +/- adjuvant therapy. In this case the patient underwent a right pneumonectomy.
  3. Is the use of this test/procedure appropriate? As an initial screening test, given the clinical history and initial presentation of the patient, this is a good first screening test. If there are any ominous findings, further investigations are warranted.
  1. Is(are) there any alternate test(s)? CT and MRI would also be useful in this situation. Both tests have their advantages and disadvantages. The patient went on to have a subsequent CT scan to confirm the diagnosis of metastatic lung cancer and to investigate the left perihilar region.
  2. How would you explain to the patient about the possible risks and benefits of this test? The main risk of a chest x-ray is radiation exposure. It is minimal compared to a CT scan, but nonetheless the patient must be made aware. The benefits are it is readily available, quickly read in most circumstances, and can show a large amount of information about any underlying pathology.
  3. What is the cost of this test? I couldn’t find any exact numbers, but I would guess between $150-200 when all the costs are considered: machine, techs, physicians time etc.