Question

Elroy has had a persistent cough for almost two months with shortness of breath when walking up stairs. He has smoked for over 20 years. Last week, he made an appointment to see his physician. While waiting in the waiting room, he coughed up blood. His surgeon is concerned, obtains a sputum specimen, and orders a chest X-ray. The sputum specimen is positive for blood and negative for infection. Carcinogenic cells were seen. His chest X-ray shows a lung mass in the RLL. He calls Elroy and schedules him for a bronchoscopy, mediastinoscopy, and possible thoracotomy.

1. What is the medical term for coughing up blood? According to Elroy’s history and physical, he also complains of orthopnea along with dyspnea. Exactly what are his symptoms?

2. Due to Elroy’s history and his symptoms, what does the physician suspect the diagnosis will be? Why?

3. Why is the physician doing a bronchoscopy? What tests will be done? How will the ST assist with the procedure?

4. The frozen section from the lung biopsy is positive for small-cell carcinoma. Why is the surgeon completing a mediastinoscopy?

Answer 1

1,

Hemoptysis is the medical term for blood in sputum or coughing up blood.

Symptoms of the patient include:

hemoptysis, dyspnea or shortness of breath, breathing difficulty, chest tightness, chest pain, weight loss, wheezing, osteopnea etc. are the possible symptoms shown by the patient.

2,

Lung cancer is the suspected diagnosis of  Elroy. Because he shows the symptoms such as shortness of breath, hemoptysis, osteopnea etc. On sputum examination it shows no infection and Carcinogenic cells were detected in sputum also blood. This stongly suggest that patient had lung cancer. Also the chest X-ray shows mass in the RLL.

3,

Bronchoscopy is the procedure done for the visualization of airways inside the lungs using an endoscope. Bronchoscopy help the doctor to visualize the mass or tumor in the airways and it help to detect the size, position and any spread of tumor.

ST or speech therapy help the patient to maintain better breathing and voice clarity. Bronchoscopy cause discomfort in bronchial walls and it may lead to several breathing difficulties Speech therapy help the patient to retain from this type of difficulties.

4,

Mediastinoscopy is the procedure which used to examine the  mediastinum. This is the space between 2 lungs and behind the sternum. Mediastinoscopy help to take biopsy from lymphnodes and help to identify the stage of lung cancer. In sever cases we can remove the mediastinum to aviod spread to another lung.