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Lung Cancer

Lung nodule

10/14/2009

Question:

My mother had Edometrial Cancer and had a hysterectomy back in March of 09 she done radiation and follow ups with PET and CT and all tests have been good up until just this Sept 09 she had a CT and per the CT report they found several nodules 4mm in the right and left lung and the largest being on her lower right 1.2cm and then we followed up with a PET scan 2 to 3 days later and the report was subtle focal hyper-metabolism (SUV 1.40) in the right lower lobe but the rest of the test per the report is good. Now back in May she had a PET and CT and all was good nothing found in the lungs. In July 09 she got really sick she had a bad cold and was coughing horribly and went to the doctor he prescribed her antibiotics and she did not take them so could it be from the cold that this is showing? By the way per the CT report these are numerous solid noncalcified lung masses bilaterally again these are 4mm and just one 1.2cm.

Answer:

Nodules in lung in a patient with history of endometrial cancer is worrisome. You mentioned that the last CT showed multiple non-calcified nodules that were not present before. These may represent fungal infection known as histoplasmosis, especially if she is from the midwest, however, if they are new then we will need to follow them closely. If she had pneumonia (you did mention cold) it is possible that these could represent infection as well. PET uptake of 1.4 SUV is consistent with infection. Since these nodules were just seen on Sept CT and since we are thinking of the possibility of infection, it will be prudent to try some antibiotics and then repeat the CT in 6-8 weeks. If they disappear or if they are getting smaller then we don't have to worry. However, if they still present or getting bigger in size she will need a tissue diagnosis. Depending on the location, a bronchoscopy or CT guided biopsy can be done at that time to rule out cancer as well as infection.

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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