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Lung Cancer

Lungs nodules

12/08/2008

Question:

Hi, 2 months ago because of huge pain in my stomach, I took CT scan (first time in my life). They found that my pain is from kidney stone, but they found 1 nodule on left lover lobe. I was afraid and I asked my doctor for next step. He sends me to x-ray. On x-ray did not find anything. I asked again for CT scan, even I know it is not good to have that in short period of time, but I took it again. Now they find on left and right lungs around 15 small nodules, sizes between 2-6 mm. I`m 99% sure I never had TB. Doctor told me do not worry but to be safe he send me to doctor for lungs. Now I`m waiting for that app. I was smoker more than 20 years, quit 3 weeks ago. Any idea what are this nodules?

Answer:

Multiple nodules in the lung could be from infection (viral, fungal or bacterial), TB, sarcoidosis, rheumatologic diseases and also metastatic cancer or lymphoma. Depending on other factors such as age, smoking status, history of any other cancer, appearance on CT, we estimate the likelihood of malignancy. Sometimes, a resolving pneumonia may have a very similar appearance. If you were smoking until 3 weeks ago and you were having cough and sputum production, there is a good possibility that this could be an infection. In the midwest USA, possibility of fungal infection with histoplasma is also high on the list. Without looking at the CT it is hard to say what they are from. In benign cases, sometimes they may disappear over time and so a follow up CT in 3-6 months may be helpful. If any of the nodules are bigger than 10mm, a biopsy or further imaging (high resolution CT) studies may be a possibility (in your case they all range from 2-6mm). The best course at this time would be to have a lung specialist review your history, symptoms and the CT to determine the management options which is already in the process. I also congratulate you on your ability to quit smoking. It is never too late! 

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Response by:

Shaheen  Islam, MD, MPH Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
Hematology
College of Medicine
The Ohio State University