Question :

Lung Nodules

Dear Ask The Doctor:
I haven't been diagnosed with any type of cancer, but I didn't know what other category this would go. I have typed the results from my ct scan below. My PCP didn't have time to actually talk to me today, but another dr at the office said there was nothing to be alarmed about regarding these results. I'd like to know what they mean though. Can you tell me? I am 43, non smoker (I smoked a very short time when I was 18-23, but wasn't even every day and a pack probably lasted like 3 weeks), in good health otherwise. I have no symptoms of anything, but I did have a nasty cough recently that went away with antibiotics, it lasted for like 2 months and was productive (yellow)... it was worst cough I've ever had in my life and actually gagged me a couple of times, waking me from sleep. History: Abnormal chest x-ray. Question of a nodule in the left midlung. Findings: The spiral multidetector slices show very prominent thyroid, especially the right lobe. As the slices move down through the chest, calcified pretracheal and right hilar lymph nodes are present. Liver, and spleen, and pancreas appear grossly normal. The lung window films are then reviewed showing a very prominent fibrotic apical scarring worse on the right. The left chest shows a pleural-based 2-3 mm nodule. A density is identified in the left chest with focal infiltrate in the lingula. No calcification is identified in the nodularity. Minor stranding is seen in the right middle lobe as well. No significant pleural effusion is noted, but some atelectatic change is noted medially in the left lung base. The IV contrast is instilled. The area questioned as being prominent thyroid on the right is composed of soft tissue plus the thyroid, and therefore suggests the thyroid is normal. Enhancement of the aorta is normal. No dissection. The pulmonary arteries are grossly normal. No pathologic nodes are seen in the mediastinum. Slices into the liver and spleen show symmetrical normal enhancement. No adrenal mass can be documented. The lung window films are then repeated with IV contrast. No further information is achieved. The coronal images confirm that there are indeed 2 nodules in the left midlung, each of which is in the 6-7 mm range and uncalcified. There is also some infiltrate extending into the lingula. IMPRESSION 1. Multiple small 1-2 mm noldules throughout the lung fields felt to probably be a residual of reticulonodular lung process. The nodular area on the left shows no real calcification. Each nodular component is in the 6-8 mm range and does not enhance. 2. Multiple nodes are calcified in the mediastinum. The appearance is low-probability for malignancy.


Answer :

Dear Patient: 
I understand your concern about lung nodules. Lung nodules are small masses of tissue in the lung which are quite common. They appear as round, white shadows on a chest X-ray or computerized tomography (CT) scan. They're usually about 1/5 inch to 1 inch, or 5 millimeters (mm) to 25 mm, in size. A larger lung nodule, such as one that's 25 mm or larger, is more likely to be cancerous than is a smaller lung nodule.
According to your description, due to the characteristics of the nodule such as size, localization and presence of calcification it is very probable that your nodule is benign. The cause might have probably be due to an infection, cyst, hematoma and usually require no treatment. Your doctor might have already told you that the management of this condition would be to observe this nodule from time to time, for example in a year you might need to take another CT scan to compare it with the actual one and look for changes in size and appearance. If any change is noted, you might probably need to have a biopsy. In the meantime I would suggest you to consult your physician for a more detailed evaluation and explanation of the condition. I wish you the best.
 


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