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Talcoma: The Confounding of a Differential Diagnosis in a Patient with a Pleural-Based Mass
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A6667 - Talcoma: The Confounding of a Differential Diagnosis in a Patient with a Pleural-Based Mass
Author Block: P. Ramirez1, B. Giri2; 1Internal Medicine, Baylor Scott and White, Temple, TX, United States, 2Pulmonary and Critical Care, Scott and White Health Care, Temple, TX, United States.
INTRODUCTION. Talc pleurodesis is a procedure used to obliterate the pleural space in order to prevent recurrent pneumothorax. A talcoma is a rare consequence of talc pleurodesis. The presence of talcoma provides a challenge in diagnosis due to the rarity of its occurrence and the difficulty in differentiating it from other causes of lung masses without tissue biopsy to confirm the diagnosis.
CASE PRESENTATION. 42 year old female presented to her primary care clinic with a chief complaint of shortness of breath both at rest and exertion. She denies associated cough, fevers, chills or pain with breathing. History was significant for recurrent, bilateral pneumothoraces status post talc pleurodesis on the right (12 years ago) and left (8 years ago). She also had a 20 pack year smoking history and a strong family history of lung cancer through her paternal lineage. Initial workup included a 2-view chest X-ray which revealed a pleural based mass in the posterior left lung. Follow up CT scan showed a 1.6x3.2 cm calcified, pleural-based mass with central soft tissue in the left lower lobe. After referral to oncology due to concern for malignancy, a PET-CT was performed which confirmed a hypermetabolic left lower lobe lung mass along with multiple hypermetabolic sub-centimeter nodules in both the right and left lung. Tissue biopsy of the main left lower lobe mass was taken and pathology of the mass revealed foreign material with foreign-body giant cells and no dysplastic cells. Thus, the diagnosis of talcoma was made.
DISCUSSION. Talcoma is a rare complication of talc pleurodesis, a commonly used procedure to prevent recurrent pneumothoraces. The differential diagnosis for a pleural-based mass, as demonstrated in our case, includes metastatic cancer, lymphoma, mesothelioma, lipoma, and pleural plaques. The presence of talcoma presents a difficult challenge in diagnosis due to the rarity of its occurrence and the inability to distinguish it from other causes of lung masses without tissue sampling. The presentation of talcoma in this case, each imaging modality (X-ray, computed tomography and PET-CT) did not reveal identifiable differences that could be used to distinguish talcoma from potential malignant causes. In the end, it required biopsy to establish the diagnosis and rule out cancer. A high index of suspicion and a detailed history focused on risk factors and symptoms is required to clue a clinician into the diagnosis.
Author Block: P. Ramirez1, B. Giri2; 1Internal Medicine, Baylor Scott and White, Temple, TX, United States, 2Pulmonary and Critical Care, Scott and White Health Care, Temple, TX, United States.
INTRODUCTION. Talc pleurodesis is a procedure used to obliterate the pleural space in order to prevent recurrent pneumothorax. A talcoma is a rare consequence of talc pleurodesis. The presence of talcoma provides a challenge in diagnosis due to the rarity of its occurrence and the difficulty in differentiating it from other causes of lung masses without tissue biopsy to confirm the diagnosis.
CASE PRESENTATION. 42 year old female presented to her primary care clinic with a chief complaint of shortness of breath both at rest and exertion. She denies associated cough, fevers, chills or pain with breathing. History was significant for recurrent, bilateral pneumothoraces status post talc pleurodesis on the right (12 years ago) and left (8 years ago). She also had a 20 pack year smoking history and a strong family history of lung cancer through her paternal lineage. Initial workup included a 2-view chest X-ray which revealed a pleural based mass in the posterior left lung. Follow up CT scan showed a 1.6x3.2 cm calcified, pleural-based mass with central soft tissue in the left lower lobe. After referral to oncology due to concern for malignancy, a PET-CT was performed which confirmed a hypermetabolic left lower lobe lung mass along with multiple hypermetabolic sub-centimeter nodules in both the right and left lung. Tissue biopsy of the main left lower lobe mass was taken and pathology of the mass revealed foreign material with foreign-body giant cells and no dysplastic cells. Thus, the diagnosis of talcoma was made.
DISCUSSION. Talcoma is a rare complication of talc pleurodesis, a commonly used procedure to prevent recurrent pneumothoraces. The differential diagnosis for a pleural-based mass, as demonstrated in our case, includes metastatic cancer, lymphoma, mesothelioma, lipoma, and pleural plaques. The presence of talcoma presents a difficult challenge in diagnosis due to the rarity of its occurrence and the inability to distinguish it from other causes of lung masses without tissue sampling. The presentation of talcoma in this case, each imaging modality (X-ray, computed tomography and PET-CT) did not reveal identifiable differences that could be used to distinguish talcoma from potential malignant causes. In the end, it required biopsy to establish the diagnosis and rule out cancer. A high index of suspicion and a detailed history focused on risk factors and symptoms is required to clue a clinician into the diagnosis.
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