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Lung Cancer

Histoplasmosis or cancer

04/21/2009

Question:

I am a male, 49 years old, never smoked. My parents smoked for my first two years of life. I recently went to the ER because of very severe (9 of 10) chest pain radiating through my chest, up my neck and down my left arm. Tests revealed no heart involvement but they took an x-ray and then a CT scan. The CT scan showed a 1cm spiculated nodule. Since then I have experienced the same type debilitating pain but did not seek medical treatment because last time (less than a month ago) they found "nothning" My primary care physician pretty much blew off the CT scan saying it was probably just histoplasmosis (I live on a small farm with chickens). Only at my wife`s insistance did my doc schedule a follow-up CT. Blood results following the ER visit also revealed decreased thyroid functioning, increased uric acid, and increased cholestoral. Everything I find on line says the histoplasmosis nodules are smooth and well defined. Because this nodule is spiculated, is there greater reason for concern? (PS My doc is retiring in July)

Answer:

A 1cm spiculated nodule is worrisome for cancer, although you are at a lower risk because you are non-smoker. At this point I am not sure if this lesion is responsible for chest pain. It will depend on the location. Possibility of a benign condition such as histoplasmosis since you live in a farm is always there. At this time, a better option would be to see a pulmonologist. After assessing the risk factors, your pulmonologist may decide to follow up the nodule with periodic chest CT or may decide to get a PET scan, biopsy or surgical resection of the nodule. A PET scan is expensive and sometimes cannot differentiate inflammation or infection from tumor and so watchful waiting may be a good option. I hope this answers your question. Please let us know if you have further questions. Thanks.

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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