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Dr. Gupta
Dr. Gupta, Doctor (MD)
Category: Health
Satisfied Customers: 7922
Experience:  Vastly experienced MD Physician with 19 years of experience.
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Abnormal chest xray led to CT Scan (w/contrast) of ...

Customer Question

Abnormal chest xray led to CT Scan (w/contrast) of lungs; results 5mm noncalcified nodue in right middle lobe inferiorly with associated hazy appearance to parechyma adjacent to it; also 3mm noncalcified nodule in right lower lobe anterior and lateral immediatey posterior to major fissure; minimal bibasilar linear atelectasis; minimal posterior dependent atelectasis; minimal linear atelectasis in lingular; findings: differential diagnosis of nodules would include malignancy; some hazy increased density in right middle lobe included in region where nodule is located. Saw Pulmonologist who said may be nothing; follow-up with CT in 3 months. Concerned to wait that long. Should I get a second opinion from another pulmonologist? Please help.
Submitted: 8 years ago.
Category: Health
Expert:  Dr. Gupta replied 8 years ago.
It can really be a tough call to decide about further evaluation on the basis of a written CT report only, without the actual patient, and the CT films.
However I do believe that the present course of action is justified given the lack of any other suspicious findings on the CT (like signifcant lymphadenopathy, large size, mulitple masses, necrosis etc.)
Trying to diagnose a cancer by doing a needle biospy would be tough and may lead to complications in such a small mass, and there is a good chance that this may be an incidental finding, so waiting and repeating the test is probably the best course of action.
You could take a second opinion though, given the extent of your apprehension,
Dr. Gupta
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Customer: replied 8 years ago.
Dr. Gupta: Thank you for your prompt response. However, I just found out that I tested negative for Valley Fever which was of concern since the nodules could have very well been related to that. Now, I know that PET scans can also detect various cancers and there are blood tests, as well. I also have found out, through my own research, that these nodules could possibly be secondary to some other cancer. Your thoughts?
Expert:  Dr. Gupta replied 8 years ago.
Secondaries have usually a very characterstic appearance depending on the original cancer, and they are usually picked well on the CT. I am pretty sure that the pulmonologist would not have missed that.
PET scans are still not that accurate for size of less than 1 cm, so again this may not be very appropriate.
Various blood tests can be done if you have a primary tumor somewhere, that you are looking for, like say PSA for a prostate primary cancer that may have metastasized.
I do believe that you can most likely wait for the 3 months suggested, but given your anxiety it would probably be fair to take a second opinion to confirm the same,
Dr. Gupta