Spotlight Case September 2004. Poor Prognosis?. Source and Credits. This presentation is based on the September 2004 AHRQ WebM&M Spotlight Case in Surgery See the full article at http://webmm.ahrq.gov CME credit is available through the Web site
At the conclusion of this educational activity, participants should be able to:
A 91-year-old woman presented with 2 days of nausea and vomiting. Physical examination revealed a palpable mass in the right groin without bowel sounds. A CT scan of the abdomen showed an incarcerated hernia with small bowel obstruction. The patient was taken to the operating room for resection under general anesthesia. After extubation, she developed stridor, requiring re-intubation.
Otorhinolaryngology (ENT) evaluation revealed no evidence of laryngeal edema. However, there was evidence of significant extrinsic compression of the trachea. A CT scan revealed a thyroid mass. A fine needle aspiration (FNA) biopsy was performed but was inconclusive. A repeat FNA was performed.
The attending physician met with the family to discuss the patient's prognosis and direction of care. He explained that the prognosis was likely very poor, as he suspected malignancy. Given this news, the family decided not to pursue surgical intervention (tracheostomy).
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Christakis NA, Lamont EB. BMJ. 2000;320:469-72.
After further discussion, the family decided to withdraw care, because the patient had stated previously that she did not want to be intubated for a long period. Shortly after extubation, the patient died.A few days after the patient's death, the results of the second FNA were obtained. The biopsy revealed a benign nodular goiter.
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Walter LC, Covinsky KE. JAMA. 2001;285:2750-6;
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In Balducci, et al, eds. Comprehensive geriatric oncology. 1998.
Adapted with permission from (see note): Comprehensive geriatric oncology. The Netherlands Harwood Academic Publishers. 1998:295; Figure 20.1.