So, my dad had a routine chest x ray in Sept '08...completely unremarkable...practically perfect lungs! He had a horse accident in November in which he broke his 10th and 11th ribs on the right side...10 was pretty sharp and pointy and he was told to be careful so that he did not get a pneumothorax. All was fine for a couple of months sort of..naturally it was very painful for him when breathing b/c of the rib fx; then in March he developed a nasty(but productive) cough and fever. A chest x ray showed he had pnuemonia in the right lower lobe(around the 10th and 11th rib) but unremarkable otherwise. Had a f/u cxr a month later (which I did myself since that is my field and I saw exactly what the rt lung looked like). Report showed he still had a little pnuemonia and a small pleural effusion so a ct scan was scheduled. After my dad got a call about his scan being abnormal he went to the dr and he was told he has 3 lung nodules with 4 enlarged nodes. I know many radiologists so I had one go over his scan with me (with my father's consent, ofcourse, non-HIPPA violation) Okay, so one nodule is 1 cm; another is 2 cm, and the third is over 6cm....come on...how in the world do you miss a 6 cm lung nodule on a cxr ONE WEEK EARLIER? (apparently possible, but highly unlikely) His doctor tells him that he is 95% sure it's lung cancer and has already metastasized. Hello? Does he not realize that other diseases can mimic lung cancer especially following a chest trauma. My dad also had his spleen removed when he was 12 so he has a compromised immune system, which also has lead to many problems causing him to have a not so hot health record. For one, he has an anticoagulation disorder and takes a LOT of coumadin. This doc wants to go ahead with a PET and told my dad that it would be able to tell if it was malignant or not. Okay, so as I may have mentioned earlier, diagnostic imaging is my field. I know doctors that specialize in these tests. Just like I don't go to McDonalds and order a taco, I'm not going to ask an internist to interpret a PET scan. The radiologists have told me...No, if there is an increase in metabolic activity, it will show a positive PET. It is very similar to a Nuc Med scan in which a "hot spot" attracts the radionuclides injected. Only difference is the PET can determine functionality of the organ. Okay, so increase in metabolic activity means....cancer, yes, but also any infection as well as other disorders. I'm not a physician and I really do like his doctor (he's mine also) but why tell someone you think he has cancer and order a test that tells you what the CT has already confirmed. We know something is wrong but none of this started until after the rib fx. He has a compromised immune system and he takes longer to heal. Rib fx causes lung frailty and the pain makes it difficult to breathe deep enough in that lung to clear them out which usually sets up pnuemonia. What are the chances that this is just a bad bout of pneumonia that is taking longer to clear up and is showing areas of inflammation in the lung (a.k.a. SIX cm nodules not previously detected on more than 3 imaging studies). If they do the PET, it will show hot and they'll probably order a more invasive exam such as needle biopsy(the nodules are probably too far down to reach with a bronchoscope). My dad my not be able to tolerate this with his hx of clots and is at very high risk of further infection (obviously). Shouldn't he just get a very aggressive round of antibiotics and antifungals and then have a f/u ct? I have had two radiologists and another physician I work with suggest this and also give me their reasons to believe this is a little premature. Anyone have any advice or similar situations? I don't want them to jump the gun and do possibly unnecessary invasive testing that could further compromise his health unless we know for sure that it is not improving at all. I know "malignant until proven otherwise" but sometimes the risks may outweigh the benefits when it comes to this stuff. If it is cancer and it has spread to the nodes in the hilum..he is already starting to metastasize (or already has gone further). He is not a likely surgical candidate and most likely will not be able to tolerate chemo which leaves radiation just about his only option. That may not be enough. Why jump the gun and possibly make him even weaker unless it is proven to not get better. I mean, no one saw this on the x ray, so who's to say the nodules weren't bigger a month ago and have already improved?
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