Expert: Anil Aluri MD - 9/4/2006

Question
Doctor Aluri, following is the surgeon's summation of what he did:

Flexible Bronchoscopy
Right thoracotomy
Decortication
Subsegmental resection of right upper and right lower lobes
Multiple intercostal nerve blocks

The following information is taken from the pathologist's finding:

Right lower lobe of lung wedge resection; respiratory bronchiolitis and interstitial lung disease, moderate
Calcified nodule with chronic bronchiolitis, fibrosis and scar formation
Special stains negative for acid fast,fungal and pneumocystis
Carini organisms
pulmonary emphysema,bullae,and pleural fibrosis
No granulomatous reaction or malignancy seen

The reading for the other sample was the same with the following exception:

Respiratory bronchiolitis and interstitial lung disease severe

Doctor, I remember feeling especially good the morning I reported for surgery. Therefore, I am puzzled by the fluid found in my chest

Ray

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Followup To

Question -
Doctor Aluri, following are parts of the post-operative report of the surgeon.  Would you put it into layman's language for me:


"I anticipated doing a thoracoscopy. However, the patient's pleural space was pretty much encompassed with pleural effusions,making a thorascopic approach unsafe. A decortication was done.

Several nodules palpable were then excised. These were sent to Dr. Fu for frozen section analysis, and they were returned with a benign diagnosis. Cultures are pending."

Doctor, it looks like I was wrong about there being just two excisions as the word "several" is
used here.

Ray
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Followup To

Question -
Dear doctor Aluri,

On August 4 I underwent an open lung biopsy. Two samples of tissue were taken which proved not to be cancerous. I have something called interstitial pneumonitis.  I still don't understand what it is or how it gave the appearance of possible cancer.

After the sections of lung were taken for analysis, were those two places sewn up with stitches?

Answer -
Dear Ray,

         It's good to hear from you, I like the diagnosis of Interstitial Pneumonitis better any day then cancer.
         Usually after doing the biopsy they can suture it or they just staple it I usually think it is the later that they do as they have more safety with staples then with sutures. Staple also cause less inflammation then sutures do, Now as for the question of why it would mimic cancer, that is the $64,000 question, they have calcifications which are also seen in lung cancer so that is the stickler there.
         But I am glad to hear that the procedure went well. Keep in touch Ray

A.K. Aluri MD

Answer -
Dear Ray,

         Whenever we do a biopsy of an area we will take specimens and submit them to pathology, now the lymph nodes all removed were shown to have been benign through multiple sections which the pathologist will report. I see that there was a massive fluid collection so for that purpose they could not do the procedure through a camera (Thoracoscopy) so they had to do an open biopsy and also remove a part of the covering of the lung tissue which is known as decortication. Also do you have the specific biopsy results that si given by the pathologist? If you could give me the results as to the lymph nodes ampled and the exact pathology i would be able to help.

A.K. Aluri MD

Answer
Dear Ray,

        The report that you have given me states that there was fluid in the pleural space which when placing a thoracoscope can lead to the complete blockage of the field of vision, that means that even if there is fluid there then they would have a difficult time in doing the procedure so for this purpose they had to preform a decortication which means they had to remove the outer covering of the lung and which would remove the inflammation. I have sometimes seen patients who show up with a pleural effusion that did not know they had it until we showed the x-ray to them. The pathology report was benign as per the findings,it showed inflammation and scarring in the past.This could be due to smoking? Well the important question now is how do you feel? I hope you feel better. Keep in touch

A.K. Aluri MD