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Pulmonology Quiz

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46 yr old with history of mild COPD presents with a 3 cm left upper lobe mass.  The patient has a 20 year history of smoking two packs of cigarettes a day. CT of the chest reveals no mediastinal lymphadenopathy and a moderate left pleural effusion.  PET/CT scan shows activity in the left upper lung without evidence of metastatic disease.

Thoracentesis is performed and the pleural fluid cytology reveals malignant cells consistent with squamous cell cancer. The patient undergoes chemotherapy with 4 cycles of Paclitaxel and carboplatin. There is complete resolution of the effusion and reduction in the size of the left upper lobe mass and mediastinal adenopathy by 50%.

MRI of the brain with contrast is performed for intermittent headaches, and is unremarkable.  Routine PFTs done 4 months prior to his diagnosis do not preclude resection.


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

  1.  Concurrent chemoradiation to the lung mass and mediastinal lymph nodes
  2.  Observation
  3.  Left upper lobectomy and mediastinal lymph node dissection
  4.  Pleural biopsy