Thank you for reviewing Ronald Cocks, an 89 year old gentleman with an array of medical comorbidities. Ronald has a history of prior asbestos exposure and is an ex-smoker of approximately 20 pack years. He is quite frail, although still ambulates independently with a 4-wheel frame and is currently living at a retirement village. Ronald was referred to me just prior to Christmas with a two month history of sudden onset voice hoarseness. He was noted to have a 4.5cm left upper lobe cavitatory mass in close proximity to the left upper lobe pulmonary arteries and abutting the left upper lobe pleura. A second lesion measuring 25cm in size in the left lower lobe was noted and a prevascular mass measuring almost 5cm, likely to be an enlarged lymph node was als noted. A PET scan has confirmed intense avidity of the left upper lobe and prevascular lesions with likely central …show more content…
Although the left upper lobe lesion would be amenable to percutaneous CT guided biopsy, given his frail state, the preference from his family, including his son, who has medical power of attorney to minimise any invasive procedures, we elected not to pursue a tissue