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Re: Omental Nodules on CT From: DoctorJoe@aol.com Mon Nov 24 08:11:09 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: rmodugno@aol.com: "Re: Omental Nodules on CT" Previous message: Garry E. Siegel, M.D.: "Re: Omental Nodules on CT" Maybe in reply to: allanho@aol.com: "Omental Nodules on CT" Next in thread: art fougner, md: "Re: Omental Nodules on CT" In a message dated 11/24/08 12:17:06 AM, allanho@aol.com writes: > 56 yo menopausal virgin admitted to the medicine service for right flank > pain.  CT showed moderate ascites with a few small nodules on her omentum.  One > of the nodules is near the tail of her pancreas.  Her ovaries were not > enlarged.  Chemistry & CBC are all normal.  UA has 10-15 RBC and 1+ oxalate > crystals.  History and Physical are otherwise unremarkable.  I think her right > flank pain is from passing some non-obstructive renal stones.  She is scheduled > to have a transvaginal ultrasound in the morning.  The internist is planning > to do a paracentesis.  The neareast gyn oncologist is over two hours away.  > > What do you think of the following options? > 1.  Diagnostic laparoscopy & biopsy if the paracentesis is non-diagnostic. > 2.  Exploratory laparotomy with a general surgeon with BSO. > 3.  Turf her to a gyn oncologist. > At her age, I would think cancer until proven otherwise, with something like TB as a very outside shot. If your general surgeon has oncology experience, #2 isn't so bad. But a quick and easy scope to make the diagnosis and then wake her up and make solid plans is also pretty good. So #1 or #2 work, depending on your personnel. #3 sounds a bit premature. Why would you send someone who has not been properly diagnosed to a GYN Oncologist with normal appearing ovaries (and presumably normal uterus, although you haven't specified that)? He makes the diagnosis of GI or Pancreatic cancer and then does what? She should stay close to home unless there's a compelling reason, don't you think? Any cancer markers in her blood work? Joe P. today!(http://pr.atwola.com/promoclk/100000075x1212962939x1200825291/aol?redir=http://www.aol.com/?optin=new-dp %26icid=aolcom40vanity%26ncid=emlcntaolcom00000001) Next message: rmodugno@aol.com: "Re: Omental Nodules on CT" Previous message: Garry E. Siegel, M.D.: "Re: Omental Nodules on CT" Maybe in reply to: allanho@aol.com: "Omental Nodules on CT" Next in thread: art fougner, md: "Re: Omental Nodules on CT"

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