Situation
A patient, who is an ex heavy smoker, is referred to you with two small
pulmonary nodules incidentally found on a CT scan of the chest. What would you
do ?
Firstly how fit is the patient, if unfit for a thoracotomy, then surgery has
little to offer.
Are there any old x-rays available, they may have been there for years.
Is the CT HRCT ?, if not repeat may show numerous other little nodules.
Are the nodules on the same side, or even in the same lobe ?
Is one or both of them calcified (potentially benign- but beware scar
cancers)?
Are the nodules amenable to percutaneous CT guided biopsy ?
If still undiagnosed and on different sided than repeat HRCT scanning in 3
months is probably best.
If ipsilateral, other option include
1 Observe as above with repeat HRCT scan in 3 months.
2 (Different lobes) Thoracotomy and wedge resection / biopsy +/- frozen
section +/- proceed to formal resection if fit enough