Bronchoscopy

My 85 year old Dad with emphysema was admitted to the hospital for extremely low (117) sodium.  He had a PET which showed 2 spots on his R lung and medial lymph node metabolic activity.  He underwent a bronchoscopy with negative results.  After the PET the Dr said it was very possible he had lung cancer, and that the low sodium level was related.  I'm very confused after the negative results.  His sodium has improved with resticted fluids and dimeclcycline (sp?).  His breathing is quite labored still.  Can he still have lung cancer with those results, and what is the connection with the low sodium?  His head CT was normal.

[Fernando Roque, MD]

Hi.  It is still possible for your dad to have lung cancer even with a negative bronchoscopy result.  The bronchoscope is a long flexible tube which the doctor inserts into the patient's airways to view what is inside. This procedure can detect lumps which are either located inside the airways or those which are in the lung parenchyma (the spongy material comprising lung tissue) but are large enough to impinge on the airway. If the lumps in the lung parenchyma are small, or are far away from an airway, these will not be detected by bronchoscopy. Another procedure, such as CT guided aspiration biopsy, is needed to verify if these lumps are cancerous.

Lung cancer, particularly the small cell variety, can secrete certain hormones such as vasopressin.  This hormone promotes water retention by the kidneys.  The excess water in the body dilutes the salt in the blood, resulting in low levels of sodium.

[DrBhumikaMD]

Hi,
Was a biopsy taken at the time of bronchoscopy? Has a CT scan been done for the chest? Can a CT guided FNAC be done? Yes a bronchscopy can be negative at times as the lesion might be localised or far away from the airways. You need to discuss the above questions with your physician and ask him what should be the further plan of mangement. Goodluck.

[ABQ]

Thank you for your quick reply.  A biopsy was taken during the bronchoscopy- brushings, washing, & biopsy-these samples were all negative.  A chest CT  was done  back in April which showed one lesion in the R lung, the PET was the only scan done of his chest with his current hospitalization which showed 3 areas of involvement.  The Dr. has scheduled him for another chest CT in late January to see if there are any changes.  I worried that this is not aggressive enough, and that we should be doing these follow ups much sooner.  Should I be pushier with the Dr?

[Fernando Roque, MD]

Hi. You can discuss with your doctor the possibility of having a biopsy of those three lesions seen in PET sooner. I can understand your need for urgency.  However, there is the question whether your dad is medically stable enough at this point to undergo a biopsy procedure. It may be that the doctor is delaying the work-up precisely to allow your father to stabilize.

[ABQ]

Hi- thank you again for your quick reply.  I will discuss this with the Dr.

[DrBhumikaMD]

Hi,
I think keeping the age and medical history of your father in consideration, it is important that he is clinically stable for an invasive procedure like a biopsy. It would be ebst to follow the doctor's advice and see the progress of the lesions in another 2-3 months. That would also clarify whether an aggressive approach is required or not.
In the mean time it is important, that your father has adequate nutrition and a healthy diet.
Hope this helps.
Good luck.