Apical Shadow on Xray of the lungs: Further management

Dear Ask The Doctor:  My husband has just had the results of his chest x-ray back from his doctors surgery (he has had a cough for over six months, and he has a rattle in his chest). The doctor said that there is an apical shadow on his lungs. He said that it probably isn't cancer because it's in the wrong place (is there a specific place that cancer starts??), and that it is probably an infection. However, he hasn't said what kind of infection and hasn't prescribe any antibiotics for this. He has said that my husband should go back for another x-ray in one month, and that there's nothing they can do until then because they have to wait and see if it shrinks or grows. My question is, should my husband get a second opinion, or should we 'wait and see' if he improves or declines?

Dear Patient:  Lung Cancer will usually start off and is usually located either peripherally or centrally in the lungs depending on the type of cancer. A apical shadow is more indicative of a lung infection rather than a cancer which is a well localised nodule usually on an xray. You said that your husband has been having a cough and a rattle in his chest for over six months which may indicate a lung infection . I also see that he is taking ventolin which will help with these symptoms. While you could start on antibiotics now it may be better to recheck what exactly that apical shadow is in a month before starting treatment.Many a times shadows on xray can also be artifacts or just improper exposure to the film and thus unecessary treament may be detrimental to the patient. Repeat the Xray in a month and take it from there. However having said that if he gets worsening of his cough , shortness of breath or any acute symptoms please take him to the physician or ER immediately.All the best.

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