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Lung Cancer

CT of the Chest

08/04/2010

Question:

A recent CT of the chest (W/O contrast) done as a follow up to a chest x-ray revealed the following: 1. Biapical pleural parenchymal scarring 2. Small 4.0 mm subpleural nodule right upper lobe laterally 3. Small calcified granuloma right middle lobe. The chest x-ray was done for shoulder pain I was experiencing (which showed that I had tendinitis in the shoulder) and upon examination of the shoulder, the doctor was concerned with lymphedema of the left axilla and decided I should have a chest x-ray as well, and this is when the above came out.

Is there anything to worry about? In how many months should I follow up? The strange thing is that I have had a chronic cough for a while that sounds like geese honking.  I sometimes have wheezing, and when I sit down and my lungs are pressed against the couch I feel like I can not catch my breath. Any assistance in this matter would be greatly appreciated. Thank you.

Answer:

Any lung nodule like the ones seen in your case need to be followed with CT scan of the chest. CT provides a more detailed information about the nodules including the location in the lung. The 4mm nodules are too small to biopsy and so they are usually observed with follow up CT scans.

Usually these small lesions are represent an infection or scar. In midwest a fungal infection known as histoplasmosis also very common. Depending on the age of the patient and the smoking history they may also be malignant as well. A nodule smaller than 1cm is hard to biopsy and in these cases we usually decide to follow up with CT scan to determine if they are increasing in size. Scars usually don't change, whereas infection may disappear once treated.

At this time an appointment with a pulmonologist would be helpful as s/he can weigh in the risk factors, review the CT and determine whether a biopsy or just observation with follow up CT is appropriate.

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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