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Hello this is dr. Reupert . I'm sorry to hear about the trouble you're having getting to the bottom of the mass in the chest . Fungal infection in the lung can usually be diagnosed with a urine test from a company called Mira Vista . I have had good luck diagnosing blastomycosis early with this test . It is very non-invasive obviously and just requires a tablespoon of urine . another approach that I've used to diagnose fungal lung infections is a transtracheal wash . this involves moderate to heavy sedation . Saline is flushed into the lung through the trachea and aspirated and examined under a microscope . you don't mention any symptoms like coughing, lethargy or loss of appetite . Most fungal infections cause a fever and symptoms of illness.Please write back if you have more questions.
I would like to know if this mass is enlarging, static, or shrinking. An xray would be the best way to compare it to the first one. An ultrasound is most helpful to guide the needle to the mass to re biodsy/aspirate. The wight loss does concern me, and a panel w thyroid levels would be nice to have.
Fine needle aspirates are difficult on smaller masses, and non-diagnostic results are common. Another needle aspirate would be approriate if the mass is enlarging.
I guess I missed that a 6wk follow up cxr was unchanged. In that case, I do not feel a biopsy is strongly indicated at this point. I would probably do another cxr in 6-12 weeks if no other symptoms arise. Certain fungal infections can cause a mass that leaves scar/granulation tissue that is quiet and not an active infection. Characteristicly these masses do not enlarge, and have well defined smooth borders. It would be nice to know exactly what it is, but it may be more trouble than it is worth.
I think that watching carefully and rechecking an xray is a reasonable approach.