Correct!
5. All of the above
His recurrent hemoptysis is not an uncommon problem with cavitary lung disease with superimposed Aspergillus spp. infection. Thoracic CT scan confirmed the presence of cavitary lung disease and bronchiectasis in the right and right middle lobes with a question of an intracavitary fungus ball (Figure 2).
Figure 2. Thoracic CT scan in lung windows showing cavitary lung disease, bronchiectasis and possibly an intracavitary fungus ball (Panel C).
His 6 months of voriconazole apparently failed to clear the Aspergillus spp. probably due to poor penetration into the cavities or bronchi. Therefore, consideration of other therapies should be considered (1). Bronchial artery embolization can be used to control hemoptysis. Consideration should be given to removing lung causing the hemoptysis. Bronchoscopy should be performed to confirm that he does not have a lung cancer.
Bronchoscopy was performed and no endobronchial lesions or bleeding source was identified. Bronchoscopic culture showed Aspergillus fumigatus. Radiology consultation was obtained to consider bronchial artery embolization, but was felt not to be indicated in the absence of massive hemoptysis. Thoracic surgery consultation recommended RML and RLL lobectomy.
A decision is made to proceed with the RML and RLL lobectomy.
Which of the following should be performed prior to lobectomy? (Click on the correct answer to proceed to the fith of six pages)