A Diagnostic Detective Story

Suzanne with Drs. Pribitkin, Kane, and Cowan

Suzanne with Drs. Pribitkin, Kane, and Cowan

Suzanne Berman’s persistent cough just couldn’t be explained, despite examinations from several specialists.

She’d seen an ear, nose and throat specialist and a general physician. She underwent tests for allergies and acid reflux. And, in the meantime, she went through many bottles of cough syrup before coming to Jefferson.

Suzanne finally got a diagnosis from pulmonologist Gregory Kane, MD, Interim Chair of the Department of Medicine at Thomas Jefferson University and Hospitals. During her first appointment with Dr. Kane, he asked her numerous questions including where did she grow up and where had she lived.

Her answers to those questions were the key. Dr. Kane told her he suspected he knew the cause  of her cough. The crucial clue for Dr. Kane came when Suzanne told him she was born and raised in Northern Kentucky and raised her children in Ohio.

He sent her for a CT scan of her lungs.

The scan revealed a calcified granuloma in the lower lobe of her left lung. These non-life-threatening calcifications are often the result of old, healed infections.

In Suzanne’s case, Dr. Kane suspected the cause was histoplasmosis, a fungal infection that primarily affects the lungs. Histoplasmosis is endemic to certain areas of the Midwest and results from a fungus that grows in the moist soil of the Ohio River Valley and the upper Midwest.

“It’s a unique ailment that patients can have for a very long time with no symptoms, but when it flares up, it can cause a cough similar to Suzanne’s,” says Dr. Kane. “What made Suzanne’s case even more challenging was that the largest granuloma measured more than one centimeter in diameter and had eroded into the bronchial tube serving the lower lobe of her left lung.”

Suzanne had heard of histoplasmosis, since she was from the region of the country where this infection occurs.
Still she says, “It came as a shock.”

She would need surgery, a lobectomy, to remove the lower lobe of her left lung.

Pre-admission testing for surgery, however, found that her calcium levels were elevated to dangerous levels and she would need to have one of her parathyroid glands removed before her undergoing the lobectomy.

Suzanne’s parathyroid surgery was performed almost immediately by Edmund Pribitkin, MD, co-director of the Jefferson Thyroid and Parathyroid Center.

“The four parathyroid glands sit in the neck behind the thyroid,” explains Dr. Pribitkin. “Their only purpose is to regulate the calcium levels in the body within a very narrow range. In Suzanne’s case, one of these glands was enlarged and maintaining her blood calcium at levels far higher than her body needed.”

Drs. Kane and Pribitkin consulted with endocrinologist and co-director of the Jefferson Thyroid and Parathyroid Center, Jeffrey Miller, MD, FACP, who confirmed the parathyroid condition was not connected to the lung.

“Thankfully, the timing was nothing more than coincidence,” says Dr. Kane.

Three weeks after the parathyroid surgery, Suzanne was ready for her lobectomy, performed by thoracic surgeon, Scott Cowan, MD.

“The cough was gone immediately,” reports Suzanne. After suffering for a little over a year, it had finally been resolved.
She and her husband were thrilled with the care at Jefferson. “

We are so grateful to have found Dr. Kane and his team.”

The surgery was a success and after a brief recovery in the hospital, Suzanne was resting at home and is now back to enjoying her retirement years.

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2 Responses to A Diagnostic Detective Story

  1. Patsy Sanders May 2, 2013 at 4:23 pm #

    I am so happy that Suzanne is doing well. She was one of my best friends and neighbor during the years I lived in Louisville. What a blessing that she has had such good care!

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    [...] that he brings to their care. Recently for example, Suzanne Berman turned to Dr. Kane when a persistent cough could not be explained by other specialists and got treatment after the physician’s diagnostic detective work identified the cause of her [...]

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