Lung Cancer

Question 1

Mark Wright is a 75 year old ex-smoker, retired electrician with 4 months of a persistent productive cough, weight loss and fatigue.

What is your most likely diagnosis and two other differentials?

Answer 1

Lung cancer: Age, smoking, weight loss and persistent cough
Tuberculosis: Symptoms also include weight loss, productive cough and night sweats
COPD: Linked to smoking, persistent cough and breathing difficulties.

Question 2

You take a look at Mr Wright’s hands and you see this. What is this clinical sign called?

Answer 2

Finger clubbing

Question 3

Describe this chest x-ray

Answer 3

There is an ill-defined consolidation in the right upper zone
The consolidation appears more dense than the surrounding lung tissue, indicating that it is solid and not filled with air.
Likely a pan-coast tumour

Question 4

A mass was found in the right apex (upper lobe)
Please state the name for this clinical sign and how it occurs

Answer 4

Horner’s syndrome
The apex of the lung extends into the root of the neck, and apical lung cancers can involve the subclavian artery, vein and brachial plexus.
Involvement of the sympathetic chain results in this.
You get partial ptosis, miosis, anhydrosis and an apparent sunken eye

Question 5

Label this transverse chest CT

Answer 5

Question 6

Mark has some blood test results and his sodium is 120mmol/L

Explain the cause of this

Answer 6

SIADH from small cell carcinoma
ADH promotes water retention, excess dilutes the concentration of sodium in the blood, resulting in hyponatremia.