Hi XXXXXXX

Thanks for posting the query.

I understand that you are quiet anxious at this moment. Going by your history, I understand that you are on oral medications for your Diabetes and previously you had a history of chest trauma leading to multiple rib fractures followed by pneumonia on the right side.

Your current concern is regarding the two nodules (subcentimetric) in your lungs. I would like to comment the following regarding the same:

1. First of all, let me tell you that cancer is not the only cause of lung nodules. There are a plenty of non cancerous causes of lung nodules like -cysts, fungal infections, hematoma, hamartoma, histoplasmosis, inflammation, tuberculosis, vascular problems and the list goes on.

2. Going by your history :
1. Your CT scan of the abdomen revealed no significant abnormality (Thus any primary site in the abdomen is virtually ruled out that could have caused metastasis).

2. Normally metastasis does not present as a couple of subcentimetric lung nodules in the background of otherwise normal lung findings.

3. Since a contrast CT thorax was performed, it can very well pick up metastasis and please note that most of the times these metastatic nodules have increased vascularity. No such finding was commented in your CT as per your history.

4. Coming to clinical correlation, in absence of any chest complaints at present, it is very less likely for you to be suffering from lung malignancy (absolutely neglegible chances of lung metastasis). Since lung metastasis is an advanced stage and a patient cannot be asymptomatic at an advanced stage.

5. The most probable etiology at this moment as per your history seems that the lung nodules are a sequelae of your previous episode of pneumonia and are therefore more likely to be fibrotic nodules. These are virtually harmless and are equivalent to a scar XXXXXXX that you get anywhere on your body after an episode of injury. The scar remains on your body for a long time but other than cosmetic complaint it does not affect you in any way.

6. Be rest assured that the nodules have a very negligible chance of being metastasis as per your anxiety because if the reporting radiologist sees any other signs he immediately pick it up.

7. There are certain things that increase the suspicion for malignancy:
- a swelling anywhere on your body that increases in size.
- be sure to ask your doctor to check your cervical and axillary lymph nodes when he comes from vacation.
- chest Symptoms like coughing, breathlessness, difficulty in swallowing, blood in coughing and chest pain. But you do not have any of these symptoms.
- If you are a smoker then you have an increased risk of lung cancer.

8. Normally such subcentimetric nodules need to be observed at least for a period of 2 years. Also in doubtful cases, CT guided FNAC (Fine needle aspiration cytology) from the lung nodule can be performed and sent for histopathological investigation.

9. So, I would like to advise you not to be worried regarding metastasis / malignancy at present since the clinical and radiological findings make metastasis a very rare likelihood in your case.

Hope I have answered all your questions. Please accept my answer in case you do not have further queries.

Regards.

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Hi,

Thanks for the follow up.

The throat symptoms you are having seem to be due to pharyngitis secondary to acute rhinitis (probably bacterial infection) with post nasal drip. The submandibular lymph node seems to be secondary to infection.
The difficulty in swallowing associated with malignancy is persistent and progresses with time and lymph nodes associated with malignancy are hard and fixed. Yet wait for your physician to examine your lymph nodes.

If your symptoms are troubling you, you may consider a 3 day course of macrolide antibiotic like tab. azithromycin under supervision of your physician.

In most of the cases CT abdomen spots the origin of metastasis.

My view as expressed previously is that these two lung nodules are less likely to be malignant in absence of any other supportive evidence. Remember since you are a diabetic, you are more prone to respiratory infections.

If needed FNAC from the nodule under CT guidance will clear all the doubts if any exist in your Physician's opinion.

Hope I have answered all your questions. Do feel free to ask follow up questions if any. Please accept my answer if you do not have any more follow ups.

Wish you good health.

Regards

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