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Tuberculosis

Lung Nodule and Never Ending Treatment

12/09/2008

Question:

I have a lung nodule in my upper right lobe, found by accident during a shoulder xray. It was biopsied and found to be negative for tumor and positive for inflammation. The nodule is also cavitated; and I`m told is about 2 inches round. No smears were taken at the biospsy. I then tested positive for tb and doctor(s) thought tb may be the cause of the nodule. It looks as though active tb is not present. Another cat scan is ordered for feb (3months from biopsy) If this nodule is caused by old infection, won`t it stay the same size? What is the significance of cavitation? The doctors mention that all the time. If this thing grows bigger, can it mean the biopsy could have missed cancer cells? Biopsy was done using small needle aspiration under a ct scanner. Will a nodule ever just disappear on its own?

Answer:

It is difficult to answer your question without many more details and seeing the X-rays that you have had done. The presence of cavitation suggests that if this is an infection, the organism is actively reproducing and is active. So the presence of cavitation makes an inactive infection very unlikely. The CT guided biopsy that you describe is generally helpful when the biopsy is "positive" or it shows something definite. When the biopsy does not give the doctors a diagnosis, it is reasonable to worry that the biopsy may have missed the important area. You have very reasonable questions about this situation, so keep talking to your doctors.

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Response by:

Catherine A Curley, MD, MS Catherine A Curley, MD, MS
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University