Fall and Cavitating Lung Lesion - Thursday April 12, 2012

Thank you to Dr. A. Detsky for hosting today’s morning report and to team 8 for bringing the case.

We discussed a man who presented with fall and found to have a cavitating lung lesion on the right side.  We discussed the approach to a patient with fall.  As with most medical problems, we begin by ensuring the stability of the patient.  In a patient with fall, patient may become unstable if he/she had a intracranial bleeding.  We also discussed that epidural bleeding can have “lucid” period.  The second question is whether the problem is new or old, and if old, what were the previous diagnoses and treatment.  Thirdly, is there one problem or multiple problems.

Specifically with fall, we want to assess any complications of fall (intracranial bleed, fractures, lacerations, etc…).  Then, we want to identify the etiology of fall.  Broadly speaking, it can be classified into multifactorial (sarcopenia, deconditioning, mechanical), syncope (cardiac, neurologic), and others.

We then focused on discussion on a very short differential diagnosis of a cavitating lung lesion:  TB, fungal infection (especially aspergilloma), pneumonia (especially anaerobic), and cancer.  The patient will require sampling of the lesion either via bronchoscopy or interventional radiology.

In the medical setting, our main focus on preventing falls is on treatment of osteoporosis which was based on bone mineral density, but has since been broadened to assessment of fracture risk.  Dr. A. Detsky and Dr. A. Cheung wrote a commentary in JAMA urging us all to look at the many other factors that contribute to fall (including sarcopenia, and the role of muscle strength, balance, etc…).  You can see a copy of the article here (full text via U of T Library here).