Should she have operation based on attached CT report?

Resolved Question:

Hello Doctors,

Hope you are doing well.

My mother-in-law is going to have an operation in China.
I attached the CT report in English.
But before she has that operation, we'd like to get advices from DoctorSpring.com and try to give a synthetic consideration and make decision whether she should have that operation.
So, could DoctorSping.com give advice about what's the best way to cure it? how to cure it? Should she have that operation?
If yes, what should we pay more attention and what's the advantage and risk?
If no, do we have any better method to cure it?

Thank you very much!!!


Here comes her medical history:
She is 56 years old patientold. She is 99 pound, 61inch.
Has been affected with diabetes since 1999 (16 years old patienthistory till now.).
Has hypertension since 2010, now has a history of 5 years.
Since 2005, she started to inject Novolin 30R Penfill twice a day.
In 2010, Diabetes leaded to Retinal hemorrhage, then she had a laser treatment to cure it well.
In 2013, she had cataract and she was restored to her sight by a good cataract operation.


Category: Pulmonologist

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

Dear patient,
Thanks for your query at DoctorSpring.com
Can you help us more by letting us know the name of the surgery/ what surgery that's planned?
I will also appreciate it, if you could tell us what her present symptoms were.
Did they do a pre-op work up to suggest she is fit for the procedure?
Can we have an image of the lesions? Is it possible that the lesions are accessible by Bronchoscopy or FNAC?
Regards

Dr. Jacob George P
MD IDCCM FCCP


Patient replied :

Hello Jacob, Thank you for taking care this case! Here comes my answers: #1 Can you help us more by letting us know the name of the surgery/ what surgery that's planned? Answer: Thoracoscope operations. #2 I will also appreciate it, if you could tell us what her present symptoms were. Answer: Actually she didn't has any symptom recently. We got know this when she had her anual physical examination. But before her anual physical examination, she was put on a drip of antibiotics for 7 days. We don't know what the antibiotics are. The reason why she took the infusion is that she felt not well at her belly. She suspected it's Cystitis, then she went to hospital and took that infusion. But after 7 days infusion, she still didn't feel well. Then after some days of Chinese traditional medicine(herb), it cured her symptoms. I don't know how to descripe those Chinese traditional medicine. #3 Did they do a pre-op work up to suggest she is fit for the procedure? Answer: Looks like there's no pre-op work up. But since she knew she's going to have an operation, she started to experience mood swing. And that resulted in her blood sugar is not stable and sometimes the maximun value is more than 20 mmol/L. And that hospital asked she to try best to maintan a lower blood sugar, looks like they will act the operation if not too high blood sugar. #4 Can we have an image of the lesions? Is it possible that the lesions are accessible by Bronchoscopy or FNAC? Answer: Attached the CT image only. And the end, in a short, I hope you could help to answer us, is that better choice to have this operation or not? Thank you.


Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

I consider that there is an infection in your mother's lungs, with minimum fluid around it. Ct report suggests that it might not be malignant, but something benign like infection.

Usually we do thoracoscopy if there is considerable fluid, and a diagnostic dilemma. We do that after evaluating her blood status and cardiac status.

Usually for peripheral lesions we suggest ct guided fnac or biopsy before a surgery is planned. If its central location, we try to access it via Bronchoscopy. I can not comment on which procedure to be done without seeing the images.

Strongly suggest a second opinion.
I may not go ahead with surgery straight away.


Patient replied :

Thank you very much Jacob! #1 You said "I can not comment on which procedure to be done without seeing the images." But I already attached the CT image in previous reply, did you see that?
#2 You mentioned, "we suggest ct guided fnac or biopsy before a surgery is planned". Doctors in China they said that is too small to do a biopsy...
Thank you again!


Expert:  Dr. Jacob George Pulinilkunnathil replied 2 Days.

Dear friend,

Actually there is one more film - called lung window which is more informative. I saw the ct image. My opinion so remains same. Thoracoscopy might not be beneficial. Suggest to keep under follow up.


Patient replied :

Thank you very much Jacob!
What do you mean "keep under follow up"? I mean, I am not clear.
#1 How frequently should she take a subsequent visit to hospital? The doctors in China said 3 months one time.
#2 What procedure do you think it's better for her to take for subsequent visit?
#3 If that thing in her lung doesn't become bigger, should be fine?
#4 Do we need take CT on some other parts of body?
Thank you very much again!
Have a great day!


Expert:  Dr. Jacob George Pulinilkunnathil replied 1 Day.

Please find my answers below-

What do you mean 'keep under follow up'? Meant I will ask her to remain in touch with doctor even though she may be asymptomatic and has no specific medicines. In case of any new symptoms to meet doctor urgently.
#1 How frequently should she take a subsequent visit to hospital? The doctors in China said 3 months one time.
Should be fine. I usually suggest first visit after 1 month and then once in the months.
#2 What procedure do you think it's better for her to take for subsequent visit?
Not planning any procedure right away. We will continue with chest x rays. Of it becomes larger in size, then probably a biopsy.
#3 If that thing in her lung doesn't become bigger, should be fine?
Will wait for 1 year before I can comment on that. Anything that grow in size within 30 days to 300 days needs to be followed up for malignancy.
#4 Do we need take CT on some other parts of body-
Not needed. However an ultrasound of abdomen, pelvis may be done.
Thank you and wish you good health


Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Experience: 
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
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