I recently cared for a man who was brought to the hospital with increased shortness of breath and mental status changes as his admitting reasons. Donít you love those vague descriptions? It could have been anything causing these symptoms: a urinary tract infection, COPD exacerbation, dementia, drug overdose, etc.
This gentleman, in his 60s, was alone with no family at time of admission. He was unknown to our oncology group, but he said he had been diagnosed with lung cancer with brain metastasis. Prior to this admission, he was at a rehab facility. For how long, he was not sure.
We received more information from the rehab/nursing home facility. His records did show a history of lung cancer with brain metastasis, as well as receiving radiation to his brain as one past treatment. It took a while to piece together what this gentlemanís health history was since he was not completely coherent.
Family members trickled in on various days with no one family member really taking charge of this manís care or past health history. Finally, a son shared with one of the hospital staff that at the time of his lung cancer diagnosis, the entire family decided not to pursue aggressive treatment. It was also discovered that the tissue sample from the lung biopsy was inconclusive -- not enough tissue was obtained from the presumed malignant site. Again, the family collectively decided not to put him through another biopsy.
The family refused another biopsy and asked for the radiation to the brain. This is what the manís history contained as far as his initial diagnosis.
So, working up as to why he was at the hospital was quite challenging. It took an interdisciplinary team, and the man needed a chest tube due to fluid collecting in his right lung. During this procedure, another lung biopsy was performed per the pulmonary/thoracic surgeonís recommendation. The family agreed. And guess what? No malignancy.
This gentleman was suffering from empyema! No cancer was found! This made us question whether he ever had lung cancer at all.
The mental status change was likely due to a possible superimposed, underlying infection of pneumonia.
The family was relieved, and appreciated us recommending another biopsy. The gentleman recovered with a long hospital stay and antibiotic course. His chest tube was eventually removed and he went back to the rehab/nursing home facility where he resided. We welcomed him to follow up with our group on an as-needed basis.
Have you ever seen a misdiagnosis of a malignancy? If so, how did you and your team handle it?