CT with nodules and pleural effusions

Hello! New patient for HBOT. Hx metastatic renal cell carcinoma. Has not come in for a full evaluation yet and currently limited medical records. History of thoracentesis for past pleural effusions. Had chest CT 4/11/23. Comparison 2/7/23. Impression: No substantial changes in size of bilateral pulmonary nodules since prior chest CT, most consistent with metastatic disease. Stable findings consistent with osseous metastatic disease. Small left pleural effusion, larger since prior chest CT. Trace right pleural effusion appears new. May be malignant in etiology. Retrocrural lymph nodes, one of which is borderline enlarged, larger since prior CT and may be neoplastic. Provided the patient has a stable respiratory status upon evaluation, how much of a concern are the effusions and nodules for any related barotrauma? Are CTs typically obtained after a thoracentesis as precaution for air entering after the procedure, if the patient did have this done during treatment? Thank you!

Apr 18, 2023 by Sarah Karson, RN, BSN

1 replies

Elaine Horibe Song
MD, PhD, MBA

Hi Sarah, thanks for your question. Dr Worth, Jeff, Tiff and I discussed this and from the brief description, it seems like the patient has a Stage 4 metastatic renal cell carcinoma (stage 4 metastatic renal cell carcinoma is reported to have around 8% 5-year survival rate). Without knowing the clinical context and the specific needs of the patient, the findings on the CT scan may not be relevant. It'd be important to consider the patient's overall condition (e.g. are they nutritionally or immunologically deprived, likelihood of cancer progression - seems high in this case), current treatment plan, and if medical necessity for HBOT can be justified given a specific HBOT indication, in order to evaluate risks and benefits of HBOT. Of note, current literature shows no evidence that cancer recurrence or enhanced growth can be a direct consequence of HBOT. Also, see related section 'Considerations for Active Cancer and HBOT' 'https://woundreference.com/app/topic?id=an-introduction-to-hyperbaric-oxygen-therapy_x#considerations-for-active-cancer-and-hbot'

Apr 19, 2023

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