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Lung Cancer

2 Noncalcified Nodules Found in Lung

08/26/2010

Question:

On the 9th of August 2010 I had a chest x-ray which said I had a 5 mm nodular density projecting over the right 2nd anterior rib. The next day I was sent for a CT scan of the chest without and with contrast. Report said lung windows does not demonstrate a 5 mm nodule in the right lung apex and represents an artifact of superimposed osseous and parenchymal elements. However there are 2 tiny subpleural noncalcified nodular densities in the right lung. There is a 2 mm noncalcified nodule noted 4 mm from the pleural surfaces. Also in the right upper lobe anteriorly there is a 3 mm noncalcified nodular density 1 cm from the anterior pleural surfaces. The lungs are otherwise clear.

I am a 64 year old female. I have smoked for about 30 years about 10 cigarettes daily. What are the chances that these 2 nodules are really granulomas or might this be an early stage cancer. Also, 6 months seems like a long time to me for a follow/up CT scan. If I stop smoking, is there any chance that these nodules will go away?

A follow/up CT scan of the chest is recommended in 6 months. I await your expertise.

Impression: 5 mm nodule is not identified in superior aspect of right upper lobe. Chest x-ray represents an artiface of superimposed osseous and parenchymal structures. There are 2 very small noncalcified pulmonary nodules in the right lung as described, most likely post inflammatory granulomas.

Answer:

Nodules smaller than 5mm have a <5% chance of being cancer even in a smoker.  These are usually followed with a chest CT in 6 months.  They are unlikely to grow significantly before that.  Too frequent CT's can also lead to more radiation exposure.
Stopping smoking may not make the nodules go away, but it will decrease your risk of cancer.

I hope this helps.

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Response by:

Sandra L Starnes, MD Sandra L Starnes, MD
Assistant Professor of Surgery
College of Medicine
University of Cincinnati