Situation
You are referred a patient with two pulmonary nodules, the one in the RLL is an adenocarcinoma, and one in the RUL, which is undiagnosed. Assuming the patient is fit for any thoracic procedure, what would you do ?
The lesion in the RUL needs a biopsy to exclude adenocarcinoma i.e. a met
(M1 disease). If this is not possible then a thoracotomy could be performed
after full explanation with the patient and a frozen section of the lesion in
the RUL taken.
If benign then leave alone, and deal with the RLL on its own merits.
Assuming no mediastinal disease.
If non adenocarcinoma then both nodules need removing via wedges, wedge and
lobectomy, or pneumonectomy.
If both are adenocarcinoma then decision time, 2 primaries or primary plus
metastasis.
Options then include
1 Removing both nodules via 2 wedge resections,
2 Wedge and lobectomy, or
3 Rarely pneumonectomy – you would have to be pretty sure these were
synchronous primaries with the same cell type.