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Chest CAT scan showed nodule in lower lobe. Never smoked. Wondering how serious this is?

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had a Chest Cat scan and am worried about the results.

It states there is a 3X5 mm pleural based nodule in the right lower lobe and a 4mm pleural based nodule in the left lower lobe.

I was wondering how serious this is? Another doctor read the scans as well and said the size was 4mm in the lower right and 6-7mm in the lower left.

I have never smoked a day in my life!
Posted Mon, 21 May 2012 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 20 hours later
Hi Mr XXXXXXX

Thanks for posting the query on XXXXXXX After going through your query, I would like to comment the following:

1. You seem to be having 2 subcentimetric lung nodules , 1 each in both lower lobes.

2. You do not seem to have any symptom at present.


3. I would like to inform you that, fewer than 1% of very small (<5-mm) nodules in patients without a history of cancer are malignant. Thus 99 % of such nodules are not malignant.

4. If no risk factors for malignancy are present (like smoking), then the nodule need to be observed for 12 months and a CT thorax plain and contrast be repeated at 12 months. If the nodule has remained unchanged then no further follow up.

5. PET (Positron emission tomography) is an optional alternative to check for focus anywhere else in the body. You can have your PET scan done.

6. FNAC or biopsy from such small lesions is very difficult. However a bronchoscopy can be done in your case and bronchoalveolar lavage samples can be sent for examination. If hilar adenopathy is present on CT scan then TBNA can be done through bronchoscopy.

7. We do get many patients with such subcentimetric lung nodules and most of the times its benign. Without confirmation of diagnosis surgical resection of such nodules is not an option since the nodules are present in both lungs and the size is too small.

8. Malignant lesions have some distinct features on ct scan which are not present in your case nor are any other features of malignancy , either clinical or radiological, present in your case.

Thus in absence of any clinical features or risk factors, observation is the best strategy. A PET scan is a good option.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
Follow-up: Chest CAT scan showed nodule in lower lobe. Never smoked. Wondering how serious this is? 5 hours later
Would a 12 month follow up be ideal or should I get another scan sooner. What about exposure to the radiation from the follow up? I do not want too many Cat Scans.
 
 
Answered by Dr. Gyanshankar Mishra 15 hours later
Hi XXXXXXX
Thanks for the follow up. After going through your follow up study, I would like to comment the following.
1. Since your lesion is subcentimetric, there are high chances that it is not visible on plain chest xray. Hence a ct scan would be required for monitoring.

2. Ideally a lesion should be monitored for a minimum period of 12 months and a ct scan at the end of 12 months is the feasible option for that. A plain xray at the end of 2nd year will be adequate after this if the 12th months ct shows no progression.

3. Though ct is associated with radiation, but the benefits far outweigh the risks in your case and hence a follow ct is recommended. If the lesion is visible on mri then mri thorax could have been an alternate option considering your concern for radiation.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
Follow-up: Chest CAT scan showed nodule in lower lobe. Never smoked. Wondering how serious this is? 3 hours later
What is generally the protocol if the nodules increase in size......say from 4mm to 9mm in size? At what point is any kind of action recommended?
 
 
Answered by Dr. Gyanshankar Mishra 8 hours later
Hi XXXXXXX
Thanks for the follow up. After going through your follow up study, I would like to comment the following.

Generally if a subcentimetric nodule increases in size to more than 1cm then a CT guided FNAC/ BIOPSY is recommended or if that is not possible then open lung biopsy or thoracoscopic lung biopsy (since the lesion is peripheral) are feasible options and thus a histopathological diagnosis is mandatory at that stage.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Above answer was peer-reviewed by
 
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