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Pulmonology Quiz


Question Information

 
Question Date:
  06/29/2010
Submitted by:
  Administrator
Affiliation:
  QuestionPursuit

Question

 

45 yr old presents with a 3.1 cm left lower lobe mass. He has a 20 year history of smoking one to two packs of cigarettes a day. Physical exam is unremarkable. 

CT of the chest reveals ipsilateral mediastinal lymphadenopathy with lymph nodes measuring 1.3. PET/CT scan shows activity in the left lower lobe mass without other abormality. MRI of the brain with gadolinium is negative.  PFTs reveal a FEV1 of 2.5 liters.

During the course of his evaluation he develops a symptomatic pericardial effusion. Pericardiocentesis is performed and the cytology reveals malignant cells, adenocarcinoma favored.

 

Of the following options, the next best step in the management of this patient is:

  1.  Left lower lobectomy and medistinal lymph node dissection
  2.  Concurrent chemoradiation with platinum based chemotherapy
  3.  Chemotherapy with a platinum based doublet
  4.  Radiation to the lung mass, mediastinum, and heart