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Monday, September 1, 2014
Waiting to diagnose
Hello, I have recently been told after a chest CT that I have several noncalcified nodules present bilaterally in both upper lobes and the left lower lobe regions of my lungs. I also have a small bulla in the upper left lobe. It has also been suggested that I only follow up in six months with another CT for the following 2 years. I am a little concerned, if these are not benign, what then? Won`t it be a little late to do any intervention?
Noncalcified nodules can be benign such as infection or scar; Tumor or cancer sometimes may appear as noncalcified nodules, however, when you have multiple nodules of similar nature it most likely is an infection. Not sure of your smoking and cancer history. This may be worrisome in someone who already had cancer as it could represent cancer lesions in the lung. If after reviewing your CT scan your doctor decided to wait for 6 months, s/he may be think that the likelihood of cancer is very slim. Usually we follow these lesions/nodules for 2 years total. Most tumors double in size in two years. If it is disappears during the next CT, then it was an infection or something benign. If it remains unchanged, probably it is not cancer. Another way to decide whether it is malignant or not is to do get a tissue diagnosis with biopsy. Not sure how big these lesions are. If they are larger than 1- 1.5cm sometimes it can be biopsied, however if they are small, then a biopsy will not be accurate and in that case a follow up CT is an option to see how rapidly they are growing. Depending on the location of these nodule, a bronchoscopy may be helpful to diagnose an infection or cancer. Surgery is not appropriate in your case as you have multiple nodules. You have also mentioned that you have a bulla. It could be congenital if single or may be related to emphysema if multiple. A pulmonologist may be helpful in this case (not sure if you have seen one) to determine whether watchful waiting or a diagnostic procedure such as bronchscopy or CT guided biopsy is needed.
Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University