Welcome to case number three!
My wife, who works in a primary care centre, sent this case to me. The patient is a 76 year-old male, who was operated on three years ago for carcinoma of the larynx. The PA and lateral radiographs show two nodular lesions in the lower lung fields.
The obvious response is metastatic disease. But the Muppet, trying to impress both of us, suggested an alternative diagnosis.
Can you guess the Muppet’s diagnosis?
76 year-old male with two nodular lesions in lower lung fields (PA)
76 year-old male with two nodular lesions in lower lung fields (lateral)
Click here for the answer to case #3
Answer to case #3
To the eternal shame of the muppet (and myself), my wife was right. The correct diagnosis of case #3 is pulmonary metastases. A CT study showed several necrotic masses in the lower lungs (arrows).
I thought that lower lobe infiltrates in a patient with a probable swallowing disorder made aspiration a good possibility. The muppet went even farther and insisted on the diagnosis of paraffinomas, secondary to aspiration of mineral oil.
Why was I wrong? Because I work in a big University Hospital and try to make fancy, impressive diagnosis. Forgot to follow the KISS standard: Keep It Simple, Stupid.
Teaching point: Make things simple. Dr. Felson used to say: ‘Always consider an unusual manifestation of a common disease rather than a common manifestation of an unusual disease’.
