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Dr Uzair
Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 3665
Experience:  MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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A chest x-ray revealed a 5mm upper lobe pulmonary nodule.

Resolved Question:

A chest x-ray revealed a 5mm upper lobe pulmonary nodule. The next day I had a CT of the lungs.

CT report is as follows: No 5 mm nodule in right lung apex identified but there are 2 tiny subpleural noncalcified nodular densities in right lung; in the upper lobe anteriorly is a 3 mm noncalcified nodular density which is 1 cm from the anterior pleural surfaces; in the superior lateral aspect of the right lower lobe is a 2mm noncalcified nodule noted 4 mm from the pleural surfaces

No definite nodules are noted in the left lung. Follow/up CT scan in 6 months.

I have smoked for 25+ years and somewhat concerned. Impression on report says the 2 very small noncalcified nodules are most likely post inflammatory granulomas. I am wondering about the wording about the left described as " No definite nodules are noted in the left lung". Could this mean that something was abnormal in the left lung too but they are not definite about what was seen? Should I just wait the 6 months for the follow/up or should I be seeing a lung specialist vs. a primary care physician?
Submitted: 4 years ago.
Category: Medical
Expert:  Dr Uzair replied 4 years ago.

Hi.
Welcome to JustAnswer. I shall try my best to assist you while you are corresponding with me.

 

Q. What were your symptoms?

Customer: replied 4 years ago.

I was experiencing shortness of breath and my ankles and feet were swollen. I had an echocardiogram done which was normal. Next I had the chest x-ray done. Next I had the CT scan done.

 

Since I retired, I forgot to say that the last 3 years I have been smoking about 10 cigarettes a day; light cigarettes "Carlton menthol 100's" Previous to this, I smoked around 5-6 cigarettes a day. I am 64 years old and have smoked for almost 30 years. I hope this helps. If not, please email me.

 

Carol

Customer: replied 4 years ago.
Did you get my response regarding my symptoms?
Expert:  Dr Uzair replied 4 years ago.

Carol,

 

I don't think the statement of the reporting radiologist, "No definite nodules are noted in the left lung" should be a cause for an alarm. It merely means there was no evidence of a lesion in the left lung.

As for the lesions in the right lung, they are intraparenchymal, which means they are in the lung tissue and not overlying it. The radiologist considers them to be of a non malignent nature, s/he has reported them of being post inflammatory granulomas.

 

Usually smaller nodules less than 5 mm in size are less likely to be cancerous, however, a close follow up is suggested.

Other probable causes of such nodules are previous tuberculosis, histoplasmosis (fungal infection), hematoma, vascular lesions etc. But cancerous nodules are in the list of differentials none the less and should be ruled out.

Non cancerous lesions usually do not require any treatment but a close eye is to be kept on them for any changes that might predict a serious nature. Your doctor will probably have you in for periodic imaging of these nodules for any change in size or shape or increase in number.

If the nodule appears as it was in earlier images and hasn't changed in size, shape or appearance, it's probably non-cancerous.

 

There can also be other likely causes of the shortness of breath, since you have a significant history of smoking, these causes can be ruled out on further work up, PFTs, is the right direction, conditions like COPD can be confirmed on spirometery (PFTs).

 

I think it would be better to see a Pulmonogist for his/her opinion on the non calcified nodules, as the whole point of a high resolution CT is early discovery.

 

Hope this helps, please click ACCEPT (Green Button) if it has, so that I may get credit for my time and effort. A bonus and a positive feedback will be appreciated.

Best. :)



Edited by Dr Uzair on 8/12/2010 at 9:05 PM EST
Customer: replied 4 years ago.
Do you feel that a follow/up CT scan in 6 months is appropriate or should it, in your opinion, be sooner than in 6 months?
Expert:  Dr Uzair replied 4 years ago.

Thanks for the reply,

I think 6 months is appropriate, since CT scans expose the individual undergoing them to a lot of radiation.

However, x rays and other imaging techniques that are not harmful in terms of radiation exposure can still be used, if the Lung specialist (pulmonologist) wants further work up.

 

Best.

Dr Uzair, Doctor
Category: Medical
Satisfied Customers: 3665
Experience: MBBS, FCPS (R) General Surgery. Years of experience in Emergency Medicine.
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