Patient Develops Fungal Infection Following Lung Surgery

This case involves a female patient who presented to her primary care physician with a persistent cough. An x-ray showed a large mass in the right lung and the patient was referred to a thoracic surgeon. The thoracic surgeon ordered a CT and PET scan which confirmed the existence of a malignant tumor. The surgeon recommended immediate surgery and performed a lobectomy. The lung tissue was sent for evaluation and pathology revealed a serious fungal infection.

Question(s) For Expert Witness

1. What is the work-up for a lung mass like the one seen in this scenario?

2. How often you diagnose and treat fungal infections?

3. What is the treatment of a fungal infection?

Expert Witness Response E-088005

I am a board-certified general thoracic surgeon my clinical practice is focused on minimally invasive surgery for lung and esophageal disease as well as lung transplantation. I am also an NIH funded researcher with a focus on quality care and guideline adherence in the evaluation and treatment of patients with lung cancer. Working in the Midwest, I treat a lot of patients with granulomatous lung disease presenting as pulmonary nodules. I see these patients at least once a month. Even in a non-smoker, a mass like this would be considered suspicious for cancer and I would advocate tissue sampling for confirmation. An evaluation would include PFT's, a CT and PET scan, and an office consultation. A brain MRI would also be recommended for a lesion this size. Then there would be 2 options: percutaneous biopsy or surgical excisional biopsy. Given the size of the lesion, I would likely favor a percutaneous biopsy first to confirm the diagnosis as this mass would not be amenable to a simple wedge resection. Generally, it is best to avoid a diagnostic lobectomy.