Patient: Hi, a year or so ago, closer to two, a SPN was found in my right lower lobe. I had a pet scan and it was found to be a likely granuloma as it had calcifications. This March during a check up, another SPN was found in the same lobe. I am still unclear to whether it had calcification or not, but I was sent for another pet scan. This time, there was faint hypermetabolic activity in the new nodule. No size for it or SUV. However, there is a hypermetabolic right hilar lymph node 1.4 cm and a very hypermetabolic right lymph node anterior to the trachea 1.8 cm. The cardio thoracic surgeon says it was extremely hot on the pet scan. I am scheduled for a mediastinoscopy. Could you tell me, if you saw these findings on a pet scan, what your thoughts would be? Thank you.
Doctor: Hello,Thank you for your medical query at AskTheDoctor.comI understand your concern.40 % of solitary pulmonary nod ules over the age of 35 are malignant. Imaging by itself is never a good predictor of lung malignancies, hence PET is a better modality.Now the SPN that has been detected now, is showing some metabolic activity, which is not a good sign.Besides, you also have two hypermetabolic lymph nodes, and metabolic activity indicates that the cell is active. A size of over 1 cm also raises further suspicion. If you have been a regular smoker and there is a family history of lung malignancies, then it could be due to a lung malignancy.The size and shape of the SPN are also important. Most malignancies won’t have uniform shape and will have spiculated edges which are very characteristic. Besides the size has to be over 5mm. So these characteristics also need to be important. Some infections can also cause such hypermetabolic lymph nodes, so further investigations will be required. Please update me after the mediastinoscopy.Hope this was helpful,Feel free to discuss further,Regards.
Comments / Follow Ups
Patient: Thanks so much! Do you think it’s possible this could be early lymphoma?
Patient: The doctor said the lymph node anterior to the right of the trachea is extremely hot.
Doctor: Yes, it is quite possible that is a lymphoma.
The fact that it is hot indicates increased uptake, which again indicates increased metabolic activity.
Patient: I obtained a copy of the ct report I had done prior to the pet scan. It shows my lymph nodes have increased in the past 15 months from 1 cm to 1.8 cm and from 1 cm to 1.4 cm. is this an increased cause for concern? What would be the most likely cause from this?
Is a mediastinoscopy a very accurate biopsy? If I have lymphoma or something else will it show that? Thank you.
Since the lymph nodes are increasing, it could be due to an ongoing inflammation or mostly a primary malignancy nearby.
Mediastinoscopy will definitely be helpful in the diagnosis. If required a lymph node biopsy can also be planned.
Patient: My mediastinoscopy was today. The doctor couldn’t get to the lymph node he wanted to sample. I think it was the right paratrachel or in that area. All my hyperbolic activity is in the right line. Due to a being being over it, he sampled the left node where there was no abnormal activity noted on the pet scan or otherwise. Was that a moot point? How can that node show what was in the symmetrical one of it wasn’t abnormal? Thank you.
I am not sure why exactly he did that because not all lymph nodes will have the same cells if metastasis has occurred. We always take samples from the cell showing hypermetabolic activity. Please clarify with the doctor and let me know.