Description
The patient was a middle-aged man lying comfortably in bed.
He was of average height and weight.
On examination of his head there was no abnormality
detectable.
His hands were normal.
On examination of his neck, there was no change in size or
shape; there was a small scar across the suprasternal notch. The JVP was not
elevated; the trachea was in the midline. There was no lymphadenopathy.
On examination of the chest there was no change in size or
shape of the chest. There was no obvious deformity. There was a scar across the
lateral aspect of the right side of the chest. No gynaecomastia, no abnormality
of the blood vessels.
There was no obvious dyspnoea; the respiratory rate was 14
per minute. The apex beat was in the 5th left intercostal space just
within the mid-clavicular line. Respiratory movements were equal, vocal fremitus
was normal and equal on the two sides.
Percussion note was resonant and equal on the two sides.
Breath sounds were vesicular, there were no added sounds and vocal resonance was
normal and equal on the two sides.
Analysis
§
On general examination and on examination of the head and hands,
there is no clue to the diagnosis.
♥
On examination of the chest one notices a scar across the
suprasternal notch. This would indicate that the patient has had a
mediastinoscopy (Page 256) this would
suggest that the patient has had examination of the mediastinal lymph nodes on
account of lung cancer.
ª
The only other abnormality that one can detect is the scar across
the lateral aspect of the chest wall. (Page 259)
This would indicate that the patient has had an operation on his lung
and taking into account that one suspects lung cancer because he has had a
mediastinoscopy, the most likely operation would have been a resection of lung
tissue.
¨
Since there is no tracheal deviation, no chest abnormalities, no
abnormalities in vocal fremitus, chest movements, percussion note, breath sounds
or vocal resonance; the chances are that only a small quantity of lung tissue
has been resected. This would indicate that the patient has had a wedge
resection or segmental resection rather than a lobectomy or pneumonectomy.
Diagnosis
§
Minimal resection of lung tissue for lung cancer
