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Have cold, coughing up blood, getting pain in rib and shoulder. Chest x-ray clear. Lung cancer?

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Oncologist, Radiation
Practicing since : 2007
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I have had rib pain in lower front ribs and some in left shoulder blade for 6 weeks. I have coughed up blood now and currently have a cold and cough. I had a clear chest xray and bloods. Worried lung cancer got missed on xray.
Posted Fri, 8 Mar 2013 in Lung Cancer
Answered by Dr. Dipanjan Majumder 39 minutes later

Thanks for seeking help at XXXXXXX forum.

I can understand your concern. Let me give some clarification. Rib pain is most likely to be caused by local pathology. This can be differentiated by presence of local tenderness( pain on pressing that region). Rib tenderness may be due to injury or local inflammation.

You have complaint of radiation of pain to the shoulder blade. So we have to keep in mind some visceral origin of pain. Very often anginal pain ( pain of cardiac origin), pain due to gastroesophageal reflux present in this manner. Anyway, as your other complaint is blood mixed sputum, a thorough investigation is necessary.

To detect any lung pathology, it will be better to go for a high resolution CT scan at this stage, as your chest X-ray failed to detect any pathology.

Anyway, you should also mention whether you are suffering from
-chronic non productive cough
-weight loss

It is also important to know your addiction history like smoking if any.

Consult your doctor for further investigations and a detailed check up. Please feel free to ask me for follow up.

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Follow-up: Have cold, coughing up blood, getting pain in rib and shoulder. Chest x-ray clear. Lung cancer? 1 hour later
Im am a smoker. About 15 pack years. I have a cough with my cold at the moment and have lost a stone in a month, possibly through worry. I was not losing weight until I started worrying about pains. What is the likelihood of xray missing a tumour thats causing pain?
Answered by Dr. Dipanjan Majumder 25 minutes later

You have mentioned about smoking history (15 pack years).

According to NCCN 12 guideline, your age and smoking history are suggestive of low risk group for lung cancer development.

But, clinically blood mixed sputum should be evaluated.

Chest X-ray can miss tumors in lung that depends on quality of image and resolution.In fact, conventional chest radiographs fail to detect nearly 80% of the histologically proven CT-detected lung cancers 2.0 cm or more in diameter.

The gold standard imaging is a CT scan (preferably contrast enhanced), and bronchoscopy if clinically indicated.

But clinical examination is necessary. Please consult your doctor.

I will be available to answer further queries.
Above answer was peer-reviewed by
Follow-up: Have cold, coughing up blood, getting pain in rib and shoulder. Chest x-ray clear. Lung cancer? 3 hours later
So I cannot be reassured by my xray at all?
Answered by Dr. Dipanjan Majumder 12 minutes later
Thanks for posting your query.
I can understand your concern.

Traditional book teaching says in normal chest X-Ray without prior history of bronchitis and with low risk of lung cancer (as in your case) patient can be observed for 1-2 weeks.

If symptoms not resolved, CT scan to be done.

But in my opinion, to be on the safer side, you should go for high resolution CT scan.

It is difficult to rely on conventional X-ray.

Consult your doctor; he can better guide you. Wish you a good health.
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