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Communications to the Editor |

“Diagnostic” Pulmonary Function Tests FREE TO VIEW

Mitchell L. Margolis, MD, FCCP
Author and Funding Information

Philadelphia VA Medical Center, Philadelphia, PA

Correspondence to: Mitchell L. Margolis, MD, FCCP, Pulmonary Section, Philadelphia VA Medical Center, Philadelphia, PA 19104; e-mail: margolis.mitchell@philadelphia.va.gov



Chest. 1999;116(2):587. doi:10.1378/chest.116.2.587
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Published online

To the Editor:

I offer the following addendum to the article by Kelly et al (February 1999).1

A 49-year-old male smoker developed cough and dyspnea. Physical examination disclosed clubbing and a prominent localized wheeze over the right anterior chest and trachea. Chest roentgenograms and CT showed a large right upper lobe mass with encroachment into the right upper lobe bronchus and trachea. The patient was sent for pulmonary function tests (PFTs) to assess the pulmonary reserve prior to bronchoscopy and possible lung resection.

During the initial spirogram, encouraged by the usual exhortations and encouragement to “blow it all out!,” the patient expectorated a huge (9 cm), cylindrical, slimy wedge of gray and tan tissue, which flopped onto the floor amid 10 to 15 mL of bright red blood and copious mucus. The size of the specimen was such that the pulmonary function technician initially feared the patient had somehow severed his tongue. The tissue was gingerly placed in a plastic bag and transported to the pathology department. The “gross” specimen was found to comprise fragments of squamous cell carcinoma with large areas of necrosis and fibrous tissue. The patient remained singularly unperturbed by the incident and was spared further diagnostic procedures.

Although I do not recommend this method for diagnosing lung cancer on account of its rarity and lack of aesthetic value, it does illustrate unexpected and definitive diagnostic utility for PFTs.

References

Kelly, WF, Crawley, EA, Vick, DJ, et al (1999) Spontaneous partial expectoration of an endobronchial carcinoid.Chest115,595-598. [PubMed] [CrossRef]
 

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References

Kelly, WF, Crawley, EA, Vick, DJ, et al (1999) Spontaneous partial expectoration of an endobronchial carcinoid.Chest115,595-598. [PubMed] [CrossRef]
 
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