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Thoracic surgery
Two thoracic surgeries and no diagnosis: is it lung cancer?
  1. Daniella Draicchio,
  2. Alexander Fox,
  3. Louise Haine,
  4. Robert Berg,
  5. Judith Hampson
  1. Department of Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
  1. Correspondence to Dr Daniella Draicchio; daniella.draicchio{at}nhs.net

https://doi.org/10.1136/thorax-2024-221953

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    A 69-year-old never-smoker was referred to a lung cancer assessment clinic in June 2022 with 4 weeks of exertional breathlessness, haemoptysis and fever, persisting despite three antibiotic courses. Medical history included a kyphoplasty and paroxysmal atrial fibrillation (PAF) requiring radiofrequency catheter ablations in July 2019 and February 2022.

    He had a previous episode of fever and haemoptysis in December 2019. Chest X-ray showed left basal consolidation and a small pleural effusion, with subsequent symptomatic and radiological resolution after antibiotics.

    At presentation to the lung cancer assessment clinic, blood tests revealed a C-reactive protein of 32 and weakly positive p-antineutrophil cytoplasmic antibody. Chest X-ray showed an opacity in the right lower zone (figure 1), and subtle pleuroparenchymal shadowing at the left base.

    Figure 1

    Chest X-ray on initial referral (left) and after 4 weeks (right) showing a right middle lobe nodule (arrow) and …

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    Footnotes

    • Contributors DD drafted the paper and is the guarantor. JH, RB and AF revised the draft paper. AF explained and administered the consent form to the patient. LH reviewed the imaging and figure titles.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.