presentation was at that stage naturally based on suspicion only and it was for this reason that he referred him to the RAH for more detailed medical analysis. Upon admission to the RAH on 5 November 2007 it was recorded that Mr Miller had suffered from shortness of breath and a cough. He also reported intermittent fevers and sweats. There had been some significant weight loss and lack of appetite. He had been a smoker, albeit until 26 years previously. A provisional diagnosis of probable lung cancer was made. In realistic terms, this diagnosis could only have been confirmed by way of tissue sampling from the suspected site within the lung and histological analysis of the same. This analysis would not occur at any time during Mr Miller’s admission and so the diagnosis remained one that was thought to be probable, and on a provisional basis. In the event, post mortem examination would ultimately reveal that there was no evidence of lung cancer anywhere in Mr Miller’s body. On the following day, 6 November 2007, Mr Miller exhibited confusion, headache and a fever. scan of his head was conducted that day and lesions suggestive of metastases within the brain were identified. These metastases were thought to be the result of a likely spread of lung cancer. There is no doubt that the radiological observations were consistent with such a picture. If such a diagnosis were correct, the prognosis for Mr Miller would have been extremely poor. In order to confirm a tissue diagnosis of lung cancer, a bronchoscopy was arranged. However, the difficulty was that Mr Miller had been placed on Clexane, an anticoagulant that had been prescribed in respect of the suspected pulmonary vein thrombosis. It was believed that the risks of bleeding that this would present during an invasive procedure such as bronchoscopy were not acceptable. The bronchoscopy was therefore postponed and in the event an alternate decision was thenmade that Mr Miller should undergo a CT guided biopsy. On 8 November 2007 a CT guided lung biopsy was attempted by a radiologist, Dr Brett Lorraine. A local anaesthetic was used to facilitate this invasive procedure. This procedure had to be abandoned because Mr Miller was irritable and unable to tolerate it. Dr noted that just prior to entering the lesion within Mr Miller’s lung, Mr Miller complained of shortness of breath and sore bottom’ and did not wish to ‘a continue with the procedure. This reaction was said to be an unusual one in a patient
presentation was at that stage naturally based on suspicion only and it was for this reason that he referred him to the RAH for more detailed medical analysis. Upon admission to the RAH on 5 November 2007 it was recorded that Mr Miller had suffered from shortness of breath and a cough. He also reported intermittent fevers and sweats. There had been some significant weight loss and lack of appetite. He had been a smoker, albeit until 26 years previously. A provisional diagnosis of probable lung cancer was made. In realistic terms, this diagnosis could only have been confirmed by way of tissue sampling from the suspected site within the lung and histological analysis of the same. This analysis would not occur at any time during Mr Miller’s admission and so the diagnosis remained one that was thought to be probable, and on a provisional basis. In the event, post mortem examination would ultimately reveal that there was no evidence of lung cancer anywhere in Mr Miller’s body. On the following day, 6 November 2007, Mr Miller exhibited confusion, headache and a fever. scan of his head was conducted that day and lesions suggestive of metastases within the brain were identified. These metastases were thought to be the result of a likely spread of lung cancer. There is no doubt that the radiological observations were consistent with such a picture. If such a diagnosis were correct, the prognosis for Mr Miller would have been extremely poor. In order to confirm a tissue diagnosis of lung cancer, a bronchoscopy was arranged. However, the difficulty was that Mr Miller had been placed on Clexane, an anticoagulant that had been prescribed in respect of the suspected pulmonary vein thrombosis. It was believed that the risks of bleeding that this would present during an invasive procedure such as bronchoscopy were not acceptable. The bronchoscopy was therefore postponed and in the event an alternate decision was thenmade that Mr Miller should undergo a CT guided biopsy. On 8 November 2007 a CT guided lung biopsy was attempted by a radiologist, Dr Brett Lorraine. A local anaesthetic was used to facilitate this invasive procedure. This procedure had to be abandoned because Mr Miller was irritable and unable to tolerate it. Dr noted that just prior to entering the lesion within Mr Miller’s lung, Mr Miller complained of shortness of breath and ‘a sore bottom’ and did not wish to continue with the procedure. This reaction was said to be an unusual one in a patient
MILLER%20Allan%20Kenneth.docx