84-year-old man with B cell lymphoma and new sinus masses
- Diffuse large B cell lymphoma, secondary to mycophenolate
- R-CHOP chemotherapy
- New onset headaches and diplopia – PET-avid sinus lesions
- Profoundly frail and deconditioned. CFS = 6, DASI 2.9 METS
- Multiple hospital admissions this year including ICU stay for neutropenic sepsis and 40-dayhospital admission
- Renal Transplant 2014 – live donor kidney from wife. Native polycystic kidney disease.
- IDDM – secondary to methylprednisolone for acute transplant rejection
- Severe MR – Mitraclip in Nov 2020 post chordae rupture.
- Regular cardiology follow-up until lymphoma diagnosis, current plan to focus on cancertreatment.
- Recent echo – mild to moderate residual MR, Moderate concentric LVH, low-normal systolicfunction, moderate to severe pulmonary hypertension, and severe LA enlargement.
- Paroxysmal AF – not currently anticoagulated
Reason for procedure
- Diagnostic vs therapeutic – patient and family believe it may help to resolve his headaches
- Discussed with ENT – diagnostic procedure only. Requested by oncologist. The Surgeon doesnot think it will add any therapeutic benefit.
- Surgeon and oncologist to have further discussions
Opportunity for optimisation
- Discussed with Prof Fletcher, last echo reassuring. Patient on optimal cardiac therapy.
- Significant level of frailty and deconditioning are concerning
- High-risk patient and low risk procedure
- Ascertain if biopsy will significantly affect the management of his malignancy
Advanced care planning
• No documented advanced care directive in notes
- Await outcome of discussions between oncologist and ENT surgeon
- Liaise with patient regarding ACD