Endgames Picture Quiz

An incidental finding in a preoperative chest radiograph

BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d6943 (Published 03 November 2011) Cite this as: BMJ 2011;343:d6943
  1. Graeme Currie, consultant chest physician,
  2. Kimberley Fraser, specialist registrar in respiratory medicine,
  3. David R Miller, clinical fellow in respiratory medicine,
  4. Mahendran Chetty, consultant chest physician
  1. 1Chest Clinic C, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
  1. Correspondence to: G Currie graeme.currie{at}nhs.net

An 88 year old woman who had never smoked was found to have a left lower zone mass on chest radiography before elective total knee replacement for osteoarthritis. Other than weight loss, she had no other symptoms. Her medical history included hypertension and anterior resection for Dukes’s A rectal cancer complicated by postoperative deep vein thrombosis eight years earlier; she had no history of tuberculosis. Cardiorespiratory and abdominal examinations (other than a scar) were normal; performance status was 1. Routine blood tests and carcinoembryonic antigen were normal and negative, respectively. Chest and abdominal computed tomography was performed (figs 1 and 2), with abnormalities noted only within the thorax.

Fig 1 Computed tomography of the chest

Fig 2 Computed tomography of the chest (at a different level from that of fig 1)

Questions

  • 1 What does performance status measure?

  • 2 What abnormalities do the computed tomography images show?

  • 3 What is the differential diagnosis in this patient?

  • 4 What is the best relatively non-invasive investigation that can confirm the diagnosis?

Answers

1 What does performance status measure?

Short answer

The Eastern Co-operative Oncology Group/World Health Organization performance status is used widely in patients with cancer to measure their general wellbeing and ability to perform (or otherwise) daily living activities.

Long answer

Performance status is often used as a general guide to help …

View Full Text

Sign in

Log in through your institution

Free trial

Register for a free trial to thebmj.com to receive unlimited access to all content on thebmj.com for 14 days.
Sign up for a free trial

Subscribe