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Dr. Andrew Rynne

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What does a noudule in lung suggest?

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Dr. Shashi Dangwal

Pulmonologist

Practicing since :1979

Answered : 1126 Questions

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Posted on Wed, 6 Aug 2014 in Lung and Chest disorders
Question: Hi , mom is 52 and she is a non smoker, though her husband smokes (but not around her) . and this is her quick story. My mom developed Bronchitis back in the fall around November she had it on and off all winter, had antibiotics and sterioids it finally got better in early spring but she was left with a bad dry cough, turns out she was diagnosed with asthma thru a PFT, and other things. she was put on singular and an inhaler, anyway in January and in April her chest xrays have come back negative. But my mom has been seeing an allergist because since like March she has had these chronic hives, and they don't know why- but after being on allergy meds they have gone away. She had normal blood work except been diagnosed with "High eosinophilia" but that's it all her blood work is normal otherwise. they did another chest Xray on her yesterday (July) and they found a "1 cm small density nodule" in her lung - she goes for a CT tomorrow- I am SO VERY CONCERNED that this is cancer. what is the possibility could it be benign? or just from the bronchitis? or a scarring ? why was it not there in April but its there in July? she also had a urinalysis that showed "small bacteria and small blood" in urine - she is to repeat that. Please tell me is this gonna be cancer? she is 52 nonsmoker (NEVER smoked) medical history consists of asthma and bronchitis and hysterectomy due to adhesions and endometrosis. please help me
doctor
Answered by Dr. Shashi Dangwal 10 hours later
Brief Answer:
The lung nodule should be investigated thoroughly.

Detailed Answer:

Hello XXXX

From your description, it is clear that your mother has asthma and other allergies(hives) for which she is taking treatment and is feeling better.

Now, coming to the nodule in the lung-it seems to be a new development. Either it was not there in XXXXXXX and Apr or could not be picked up earlier because of small size.

There are many causes for nodules in the lungs like infection , allergies, collagen vascular disease neoplastic. Though smoking is an important risk
factor but it does not mean that all non smokers do not have any lung problems. Beside can you completely rule out passive smoking since her husband is a smoker.

Just by looking at the picture, it`s not possible to say if it is benign or malignant.
The dictum is that any shadow in the lung should not be left alone and should be investigated thoroughly. She should undergo CT chest as soon as possible and follow her doctor`s advice. If required, she may have to undergo a biopsy also and further course of action will be decided by her doctor depending on the test reports.

Hope this answer helps you. If any further questions, will be happy to help.

Regards
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Shashi Dangwal 8 hours later
Hi doc ct results came back today and the nodule ended up being a shadow of her ribs (she has old broken ribs) anyway but it showed nothing except I did show mild medialstinal and mild left hilar lymphodenoathy no enlarged spleen no axilla lymph nodes enlarged . Normal lungs either wise . . . Now her CBC was normal except he has I guess according to the doctor. High esonophilla . She has asthma very bad allergies and like I said bronchitis in the winter and late spring . . . Should I be concerned for her for lymphoma ? Or is this probably infection or asthma or somehing else? She has no symptoms of anything other than a cough with clear mucous and a lingering cough since bronchitis and chronic hives but since she's been on allergy meds no hives

Doctor this is what the CT results say does this mean she can still have a cancer? I am scared , I looked up neoplasm, what could this possibly be?!?!

?HISTORY: 53-year-old female who had recent chest x-ray which describes 1
cm patchy nodular densities overlying mid to lower right lung, not
observed previously. Eosinophilia. Cough.

TECHNIQUE: Sections through chest after intravenous contrast. Coronal
reconstructions were performed.

Contrast 1: Omnipaque 300 Dose 1: 50cc Route 1: IV

CTDLP: 126 mGy*cm Dose Reduction: Dose Modulation On Yes

COMPARISON: Chest x-ray: 7-17-14, 4-7-14. No comparison CT chest or
abdomen.

RESULTS: No discrete lung parenchymal mass. No pleural fluid or
thickening.

Mildly enlarged mediastinal lymph nodes are noted. One of the largest is
noted within anterior right pretracheal region: 1.6 x 1.2 cm (SP 1:15
). A mildly enlarged left hilar lymph node is noted: 1.2 cm. No enlarged
right hilar or axillary lymph nodes.

A round 2.6 cm fluid attenuation lesion is noted within upper right
kidney suggestive of a cyst.

No enlarged lymph nodes within upper abdomen. Spleen not enlarged.

Deformity of posterior aspects of multiple right ribs is noted,
consistent with remote healed fractures. No acute fracture.
IMPRESSION:

1. No discrete lung parenchymal mass. Multiple remote healed posterior
right rib fractures are noted, which may explain finding on chest x-ray.

2. Mild mediastinal and left hilar lymphadenopathy. Findings are
indeterminate for neoplasm. Differential diagnosis includes sarcoidosis
and lymphoma. Consider short-term follow-up CT chest in 3 months.

3. 2.6 cm round fluid attenuation lesion within the upper right kidney
suggestive of a cyst
doctor
Answered by Dr. Shashi Dangwal 8 hours later
Brief Answer:
You may repeat her CT after 3 months.

Detailed Answer:

Her CT chest only shows mild hilar and mediastinal adenopathy. There is no definite evidence of malignancy.

As suggested by the radiologist, you may repeat her CT after 3 months.

But if you are very concerned, you may go in for further tests like mediastinal lymph node biopsy( Quite difficult to access). For this consult your local pulmonologist.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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