Saturday, December 20, 2008

To Bx or not to Bx? That is the question...

I got a phone call at work yesterday.
"Are you sitting down?", Dr. F, a surgeon friend of mine asked over the phone.

"Err, yup. Shoot." I tell him. Probably wants to refer some thyroid nodule patient to me, I'm thinking. Though usually I'm the one referring patients to him and not the other way round.

"Can you see a patient for me? A man with (get this) a BIOPSY-PROVEN pheochromocytoma!"

I cringe. I can tell he's cringing as well.
We both understand the gravity of the situation. Some smart aleck physician sees an adrenal mass on this patient's CT, and before any biochemical testing, sticks a needle into it. He must have turned a few shades of white when he got the pathology report, and quickly sent this patient to my surgeon friend.
The truth is, this patient could have died from the biopsy.

Take home message: Never, ever, biopsy an adrenal mass before you rule out pheochromocytoma. These things can turn ugly real fast. I recall that 45 year old woman I saw last year who crumped after the biopsy, had a myocardial infarct, stroked and was airlifted to us with an LVAD.

And so I'll be seeing this patient Monday to ensure he's blocked adequately before he goes under the knife.

"...see no touch..."


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