Patient: Last year I had to have a pet scan when a pulmonary nodule was found during a gallbladder diagnosis. It was beneign. During a recent check up, another nodule was found. I had to have a pet scan. I have the report but my appointment is not until late April to discuss results. Can you help me decipher what they mean? Does this mean I likely have cancer?Impression:1. Development of hypermetabolic foci within the mediastinum is above. These were not readily apparent on the prior study and are suspicious in opinion. 2. Mass seen within the posterior aspect of the right lower lung with central calcification a likely representing a healing granulomatous process. This could possibly cause reactive adenopathy within the mediastinum. However, a new soft tissue density seen more superior to the mass with soft tissue calcification.If desired, cardio thoracic referral can be performed for lynph node sampling.I need an honest breakdown of these findings and to know if in a medical opinion it is likely that I have cancer. Thank you.
Doctor: Hello,Thanks for your query to askthedoctor.com for an opinion.It is evident from the PET SCAN report that there is a metabolically active lesion seen in the posterior aspect of the right lower lung that is the inferior lobe of right lung which has central calcification ( as in central deposition of calcium. this is seen in cases of active granuloma healing process which in itself can indicate a tumours pathology in the lung. Mediastinal adenopathy is suspected that is swelling and infection induced swelling and growth of mediastinal lymph nodes.These are reactionary changes following a lung infection be it focal or generalised.Not just these active lesions but a soft tissue mass growth is also evident above this metabolically active lesion indicating that there may be a possibility of developing lung cancer.As the arise of these lesions are recent and growth is rapid which is another feature of malignancy, the growth and the lesions can be cancerous. However the confirmation can be made only after a ultrasound directed lung biopsy and subjecting it to histopathological examination which if reveals any cancerous cells or atypic shall confirm pulmonary neoplasia or cancer.I hope i have answered your query and described the report in every single simpler manner in which i could.Wishing you good health,Regards
Comments / Follow Ups
Patient: Okay, so maybe the lymph nodes wouldn’t be malignancy but probably infection?
Doctor: Yes there is all possibility that the lymph node biopsy may indicate just an infectious aetiology and not malignancy in view of active granulomatous lesions seen in lung but at the same time the accompanied growth in the lung does indicate towards a differential diagnosis of carcinoma to be kept in mind as well which can be confirmed only after the mediastinal lymph node biopsies.
Patient: Thank you. I don’t see my doctor until the 23rd and cannot get her to call me back to explain this report. I’m not sure why not, but would you mind if I run by you a couple more questions regarding the report?
This is some of the narrative from the report:
A focal area of hypermetabolic activity is seen within the right side of the upper mediastinum corresponding to an enlarged lymph node. This was not readily apparent on the prior study. This is suspicious in appearance. A hypermetabolic right hilar lymph node is also identified. Within the posterior aspect of the right lung, a focal area of hypermetabolic activity is identified corresponding to a soft tissue density within the lung parenchyma. This demonstrates some central calcification and likely represents a healing granuloma. Superior to this soft tissue density which was present on the 12/27/2013 chest CT, a second nodular density is identified demonstrating faint hypermetabolic activity. This was not readily apparent on the prior study. …A prominent hypermetabolic lymph node is seen anterior to the right of the trachea measuring 1.8 cm in AP dimension. A right hilar hypermetabolic lymph node is seen anterior to the right of the trachea measuring 1.8 cm in AP dimension. Once again, focal areas of density are seen within the posterior aspect of the right mid to lower lung.
To me this all sounds bad and I’m very worried, but I can worry easier if I have a better idea of what I’m dealing with. If this report crossed your desk with a patient, what would you tell the patient in reference to the questions “is this likely cancer?”
Thank you again very much for your time.
Doctor: Again the the lymph node activity and the healing granuloma which was present since 2013 doesn’t indicate a malignancy as the growth in that case would have been at a faster rate and mets would have occurred. To me it is still a benign lesion and if diagnosis is sought then a ct guided plural biopsy may be opted for histopathological exam to identify the cause for certain.