I received a call from Mrs Farmer on a cold January day. Mrs Farmer was the mother of 27-year-old Eileen whom I took care of a few years prior. Unfortunately, Eileen had passed away a few years back, from kidney cancer. I had shared my mobile number with the family when Eileen was enrolled in hospice care. I asked Mrs Farmer how the family was doing after Eileen's passing. She said they were holding on. But the reason for the phone call was about Eileen's younger sister, Anna.

Anna had been screened for kidney cancer by the primary care physician, as Eileen had cancer at a young age. An abdominal ultrasonogram showed a 5 mm renal lesion. An MRI was subsequently done, and she wanted me to review the scan and see Anna, as she trusted me so much. I told Mrs Farmer that even though Anna had no cancer diagnosis, I would be happy to see her.

I reviewed the scan reports, MRI images and lab work and then met Anna in my office. Her mom accompanied her. The MRI report was consistent with a normal study with no tumour in the kidney. Other organs were unremarkable as well. Upon my review of the images, which had some cuts of the lower part of the lungs, I saw a shadow in the left lung which was roughly 2 cm. Later, I confirmed my findings with our radiologist at the Cancer Centre.

She had no respiratory symptoms except a dry cough for a few weeks and her physical examination was unremarkable. I decided to treat her empirically for atypical pneumonia and repeated the lung imaging, with a CT scan 6 weeks later. Sure enough, the shadow was still there like an irregular shaped nodule.

I referred her to my surgical colleague. He did a fine needle aspiration and cytology that showed atypical cells. Eventually this lesion was resected, and it happened to be a sclerosis pneumocytoma (SP) with metastasis to hilar lymph node. SP is thought to be a benign tumour with low malignant potential, but in her case, the timely intervention seemed to be crucial.

I reflected back on this story many times. It is only the family's trust which paved the way for me to review the case and her images. The outside radiologist failed to identify the lung nodule. I am no expert in MRI image review, but the basic training hammered into my brain forced me to review the images of every patient and thus, Anna's too. It is also interesting to note that this is the same family which lost a daughter to cancer under my watch. I am grateful for the opportunity to help another family member in whatever way I can. 

Note: All names have been changed for maintaining privacy.