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Case Presentation

Case Presentation. 성균관대학교 의과대학 2007313075 손의영. Chief Complain. 이 O 연 , F/71 Abnormality of Chest X-ray. Present Illness. Previously healthy 2011. 02 건강검진상 발견된 RUL 의 solitary pulmonary nodule 평소 이상 증상 없었음 2011.04.03 Lung cancer w/u 위해 입원. Other History. PMHx .

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Case Presentation

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  1. Case Presentation 성균관대학교 의과대학 2007313075 손의영

  2. Chief Complain • 이O연, F/71 • Abnormality of Chest X-ray

  3. Present Illness • Previously healthy • 2011. 02 건강검진상 발견된 RUL의 solitary pulmonary nodule평소 이상 증상 없었음 • 2011.04.03 Lung cancer w/u 위해 입원

  4. Other History • PMHx. • HTN/DM/Tb/hepatitis/Allergy ( - / - / - / - / - ) • 약물력 : Local에서 Both knee에 OA 진단 받고 Medication 중 • 수술력오른쪽 백내장 수술 (왼쪽도 받을 예정) 2010. 치질 수술 • FHx. • 넷째 오빠 심장병으로 수술 받으신 것 외에 특이사항 없음 • SHx. • occupation: 농업, 임업 • smoking: no • alcohol: no • 생강과 마가 섞인 한약재를 가끔 드심

  5. Review of system • GW / EF ( - / - ) • Weight change : 6mo 동안 6kg 증가 (d/t increased appetite ) • fever/chill ( - / - ) • Headache/dizziness ( - / - ) • Rhinorrhea/ cough /sputum ( - / + / - ) : 3YA, 일상생활 지장 X • Dyspnea (+) : ATS grade II • chest pain / palpitation ( - / - ) • anorexia/nausea/vomiting ( - / - / - ) • abdominal pain/discomfort ( + / - ) : 폭식 후 심해짐 • constipation/diarrhea ( + / - ) • hematemesis/melena/hematochezia ( - / - / + ) : 수술 하였으나 지속 • Urinary Sx (-) • Arthralgia (+) : both knee • Myalgia (-)

  6. Physical Exam • V/S 172/88 mmHg - 63 - 18 - 36℃ • G/A Generally well-looking appearance • Mentality Alert & well orientation • HEENT pinkish conjunctivae, anictericsclerae Dehydrated tongue (-) PNS tenderness(-) PTH/PI (-/-) JVP (-) Neck VE (-) Cervical LNE (-/-) Thyroid enlagement (-) • Chest Symmetric chest expansion Regular heart beat w/o murmur Clean breathing sound w/o wheezing

  7. Physical Exam • Abdomen Soft & flat Bowel sound – normoactive No tenderness/rebound tenderness No shifting dullness • Back No CVAT • Extremities Skin rash(-) Clubbing (-) Joint ROM limitation (-) Joint swelling & stiffness (-) Joint deformity (-)

  8. Imaging

  9. Spirometry / EKG

  10. Problem List / Assessment • Problem List • #1. solitary pulmonary nodule at RUL • #2. Hypertension • #3. Hematochezia • Assessment • #1 : R/O Lung cancer • #3 : Recurrent hemorrhoid

  11. Diagnostic w/u • RUL mass gun Bx • Bronchoscopy • PET

  12. Lung cancer – Dx • Screening • Sputum cytology, CXR, Low dose CT • 최근 연구에서 Benefit 이 있는 걸로 알려짐 • Tissue Diagnosis • Fiberopticbronchoscopy, Transthoracic FNA(PCNA) • Mediastinoscopy, VATS (thoracoscopy) • Operative specimen • Staging Procedures

  13. Lung cancer – Staging Lung Cancer Staging Essentials: The New TNM Staging System and Potential Imaging Pitfalls <RadioGraphics>

  14. Lung cancer – Px • Non-small lung cancer의 Stage에 따른 예후 • Stage IA : MSD 60개월 / 5YSR 50% • Stage IB : MSD 43개월/ 5YSR 43% • Stage IIA: MSD 34개월/ 5YSR 36% • Stage IIB: MSD 18개월/ 5YSR 25% • Stage IIIA: MSD 14개월/ 5YSR 19% • Stage IIIB: MSD 10개월/ 5YSR 7% • Stage IV : MSD 6개월 / 5YSR 2%

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