Chronic Obstructive Pulmonary Disease

A 69 year old senior citizen from Midnapore district was presented with complaints of shortness of breath and chest discomfort along with high gradeintermittent fever and admitted under the care of Dr. Subhankar Chakraborty (Consultant Pulmonologist).

He was a known case of Obstructive Airway Disease and being a heavy smoker HRCT of Thorax had been advised which revealed a spiculated lesion (A spot with sharp, radiating, or needle-like borders) in the Right Upper Lobe (RUL) of the lung of 1.1 cm X 1.2 cm. He was diagnosed with a large endobronchial tumour causing complete collapse of the left lung. Since, it was a solitary pulmonary nodule (SPN) and not evident in the X ray of the chest, and FDG PET CT had been advised which revealed the lesion as FDG avid thus, suspected with malignancy.

Although the lesion was too small yet the treating consultant discussed with the family members and wth their written consent proceeded with Radial EBUS guided biopsy from anterior segment of Right Upper Lobe (RUL). On FOB screening, it was seen that there was a pendunculated sessile growth with a stalk in the left upper lobe (LUL) apical segment so the consultants had to modify the plan. They snared the whole pedunculated mass (A tumour or growth attached to a surface like skin or tissue by a thin stalk - like stem) with the help of electrocautery and sent for biopsy, using mechanical debulking with gradual apple-coring, effective tumor clearance was achieved with adequate hemostasis.

Further, there was complete recanalisation of the lumen (The process of reopening an occluded or narrowed blood vessel (artery or vein) to restore blood flow). The gentleman had been stable post procedure, successfully extubated. The family members expressed their gratitude to the Department of Pulmonary Medicine,for the team effort.