Mediastinal mass

Chief complaint A 69 y/o male, presents with severe dyspnoea. History Patient has h/o Asthma, COPD and HTN. He is a chronic smoker for the past 15 years and drinks occasionally. Vitals BP: 95/ 80 mmhg, HR: 71 bpm, Resp rate: 35/min, temperature: 98.9°F. Investigations Chest x-ray shows pleural effusion on the left hemithorax. CT shows dilated mediastinum and a mediastinal mass of 10 cm. WBC: 22,000/μl, ESR: 23 mm, C-reactive protein: 25 mg/dl, SGOT: 25 U/l, SGPT: 40 U/l, Urea: 60 mg/dl, Creatinine: 0.9 mg/dl. Treatment Please comment on the treatment.

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Known c/o asthma /copd/htn presenting with dysponea Pt is in tachyapnea with hypotension Xray chest reveals pleural effusion lt side need to be tapped and analyze to consider the mediastinal mass which may be malignant lymphoma as pt is chr smoker Tlc being 22000 suggestive of infective aetiologyas crp is positive D/d infective lymphadenopathy Malignant lymphadenopathy

Thanx dr Sandeep Ghodekar
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Clinicoradiologicaly looks a case of lymphoma. Adv fluid analysis. CT guided lymph node biopsy HPE to conclude. Further management accordingly.

Mass seems to be Lymphoma Pleural effusion seems to be malignant Ad CT guided biopsy of lymphadenopathy Ad CBNAAT Sputum exam to R/O PTB lymphadenopathy for HPE to confirm lymphoma

Could be anything- Lymphoma, ALL, Thymoma, NSCLC. Need to biopsy the lesion. Can also send the pleural fluid for analysis and that can show malignant cells. If this is lymphoma you should biopsy the mediastinal mass even if the PF shows lymphoma cells .There is a famous saying in oncology "No meat, no treat"

SINCE THE. PATIENT. HAS. . A. HISTORY. OF. CHRONIC. ILLNESSES.... SO.... MAYBE.. . IMMUNOSUPPRESSED. .. DUE. TO. LONG. TERM. CORTICOSTEROIDAL. USE. .. ...ADVISABLE... RULE. OUT INFECTIVE. PYOGENIC. ETIOLOGY ..

Needs further investigation and evaluation to conclude like CT GUIDED lymph nodes biopsy and pleural fluid analysis. Treatment as per reports.

Thanks Dr Dinesh Gupta
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See nature of mass and its effects on surrounding structures treat specefic to mass

To r/o mediastinal mass kindly adv CT angio chest