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Friday, April 18, 2014
Resolution of pulmonary nodule
I went for a core bioposy today and it was halted because the film showed the nodule had decreased by 50% and was hollow inside. Does this represent infection that has resolved itself and am I assured this was not cancer? Do nodules do this? I can find nothing on line that talks about this happening to a nodule. I know I stand another cat scan to follow up, but am I correct in relaxing about this and knowing my body took care of it? Thanks
A hollow nodule (or cavitary mass as we call it) can be seen with infection or some specific tumors. However, a tumor continues to grow whereas with infection the nodule may become smaller with antibiotic treatment. Sometimes, it may be from inflammation and the lesion gets smaller with as the inflammation improves. So, whenever we see a nodule that is smaller on a follow up CT, we think that it is probably infection and the chances of malignancy is lower. Tuberculosis is another possibility depending on the location of the nodule. A TB skin test may be helpful to rule it out. An appropriate approach at this time will be to wait and repeat another CT unless you are coughing up blood, phlegm or have other symptoms. However, if you are symptomatic and depending on the location your physician may want to do a bronchoscopy to obtain a specimen for culture or biopsy if a CT guided core biopsy is too risky. If it is getting smaller in size and does not appear on the follow up CT, most likely it was an infection or inflammation and you don't need to worry at all.
Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University