eConsult reassures Beacon patient

Elkhart native Jackie DeNova Vite remembers the first time she suffered a collapsed lung.

As a 17-year-old Elkhart athlete playing forward for the Concord High School girls’ soccer team, she collided with another player going for the ball during a game and she took a hard fall to the ground.

When Jackie sat down on the school bus afterward, she felt a sharp pain on her right side.

She found herself having to inhale deeply to breathe, but she didn’t think anything was wrong. That is, until practice the following week when her coach told her she needed to see a doctor.

“I couldn’t catch my breath, so he convinced me to get it checked out,” she said.

Tests and X-rays determined Jackie had pneumothorax, or a collapsed right lung.

Following treatment, Jackie didn’t experience any problems again until mid-October.

She woke up one morning and felt a familiar sharp chest pain on her right side and some shortness of breath. Only this time, there hadn’t been a traumatic event preceding it.

“Nothing had happened. But when I would bend down, I literally felt my lung just slap my ribs,” she said. “I couldn’t believe it, but it happened before and I knew how it felt, so I went to the doctor.”

Jackie underwent a series of tests that led to a potential diagnosis of spindle-cell neoplasm, a slow-growing malignant tumor found in connective tissue. She was referred to Memorial Regional Cancer Center.

“I was in shock,” said Jackie, who is now 21.

Because of its uniqueness, the case was brought to Dr. Javed Malik, Beacon Medical Group oncologist, and to the multidisciplinary tumor board. This local board brings numerous specialists – pathologists, interventional and diagnostic radiologists, and medical and radiation oncologists – around the table to weigh in on complex cases.

“Hers was a very unusual case, since spindle cell is a rare type of lung malignancy,” Dr. Malik said.

Less than one percent of all lung malignancies turn out to be spindle cell.

“It was especially unusual to see this type of condition for a 21-year-old who had no real predisposing history,” he added.

After discussing the case, the tumor board decided to request a second opinion from specialists at Mayo Clinic.

As a member of the Mayo Clinic Care Network, Beacon physicians can consult with Mayo Clinic specialists on tough cases – keeping patients close to home for their care.

“We’ve had great success with eConsults for other patients, especially very unusual or complicated cases like hers,” Dr. Malik said. “Based on statistics alone, it was very unusual, so it warranted a second opinion from Mayo Clinic.”

Mayo Clinic’s review of Jackie’s records confirmed that Jackie had suffered more of a thromboembolic event, which could be a blood clotting disorder and something benign, Dr. Malik said.

Jackie did not have spindle-cell neoplasm.

She did not have cancer.

“Whenever we can tell a patient who was initially diagnosed with cancer that they do not have cancer, it is amazing. Especially for her, being such a young patient, not to have to deal with this,” Dr. Malik said.

“We rely on everybody’s specialties, but sometimes with unusual cases it’s difficult to make a 100 percent concrete decision on a diagnosis, especially with ambiguous cases. Sometimes you need another specialist to look at a case,” he added.

Jackie will have more testing with the pulmonologist.

“We are looking at other avenues of what else could have been an underlying cause. But there is no evidence of cancer,” Dr. Malik said.

Jackie still suffers some neurogenic pain on her right side. And without a doubt, she looks forward to the day she finds out what caused her lung to collapse not once, but twice.

But now she feels peace of mind.

“I don’t have cancer,” she said. “That’s a big-time relief.”