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Respiratory Disorders (Expert Forum)
Ct Scan shows 11 mm granuloma
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Ct Scan shows 11 mm granuloma
by frost45, Feb 07, 2006 12:00AM
I had a heart CT scan last September, it was fine however it captured my lower lungs an revealed an 8 mm soft tissue mass. My doctor thought it was histoplasmosis and recommended another CT in 3 months, It had grown to 11 mm. Doctor recommended I see a thorastic surgeon, he recommends taking it out through laproscopic surgery, and is malignant a lobe removal. This is to much, from possible histoplasmosis, to lobe removal?? The surgeon says about 80% of things like this he removes are malignant. I feel like I need a second opinion, or a test for histoplasmosis, I don't smoke, quits 30 years ago. Where should I go, I want to be thorough before plunging into surgery
Doctor's Answer
by National Jewish, Feb 16, 2006 12:00AM
, Feb 16, 2006 12:00AM
The mass you describe falls into the category of solitary pulmonary nodule or "coin lesion". These granulomas are frequently found when a chest x-ray or CT scan is done for some other reason.
You should make every effort to locate all previous chest x-rays for comparison. The granuloma may have been present years ago, but not identified. Also it could have been deemed inconsequential by the radiologist. Discovering that this granuloma has existed for years may be the deciding factor of whether or not to have surgery.
In certain parts of the United States fungal infections are a common cause of granulomas. Histoplasmosis is a fungus that is found in the soil where there are large numbers of birds or bats. In the United States Histoplasmosis occurs frequently in the Ohio and Mississippi River valleys. Skin or blood testing for Histoplasmosis is not very helpful in determining the cause of your problem when you have lived in a part of the country where Histoplasmosis is common. Coccidiomycosis (Valley Fever) is a fungus that is found in the soil where there is a semi-arid to arid climate with hot summers, few winter freezes, sparse flora, and low altitudes. In the United States Coccidiomycosis occurs frequently in the southwest.
There are alternatives to conventional surgery and video assisted thoracoscopic surgery (VATS). CT guided needle biopsy and/or aspiration is especially suitable for granulomas that are close to the chest wall.
Over the years multiple criteria have been developed in attempts to distinguish whether or not a granuloma is cancer. These include, but are not limited to:
· absolute size,
· doubling time, the time it takes for the volume to double,
· calcified or non-calcified,
· degree of density,
· frequency of such granulomas, often due to fungi, in the general population of certain regions, such as Histoplasmosis in the mid-west and Coccidiomycosis in the southwest of the US,
· smooth or irregular margins,
· smoking history, and
· person's age.
Here are some examples of application of the criteria. The size of this 11-millimeter (mm) granuloma falls into the category of small. The majority of small granulomas are not cancer. A minority of 20 to 40% of small granulomas is cancer. Although this is a minority, it is still a sizable portion. So size alone must not be the sole determinant. Rapid growth also favors not being cancer, such as doubling in volume in about 30 days.
The application of these criteria to a specific granuloma is a science best practiced by thoracic radiologists and also by pulmonologists. You should seek consultation with these specialists. Do not rely solely on the opinion of a thoracic surgeon. Bottom line -- do not rush to surgery, as recommended. Seek further consultation from both a pulmonologist and a thoracic radiologist.
You should make every effort to locate all previous chest x-rays for comparison. The granuloma may have been present years ago, but not identified. Also it could have been deemed inconsequential by the radiologist. Discovering that this granuloma has existed for years may be the deciding factor of whether or not to have surgery.
In certain parts of the United States fungal infections are a common cause of granulomas. Histoplasmosis is a fungus that is found in the soil where there are large numbers of birds or bats. In the United States Histoplasmosis occurs frequently in the Ohio and Mississippi River valleys. Skin or blood testing for Histoplasmosis is not very helpful in determining the cause of your problem when you have lived in a part of the country where Histoplasmosis is common. Coccidiomycosis (Valley Fever) is a fungus that is found in the soil where there is a semi-arid to arid climate with hot summers, few winter freezes, sparse flora, and low altitudes. In the United States Coccidiomycosis occurs frequently in the southwest.
There are alternatives to conventional surgery and video assisted thoracoscopic surgery (VATS). CT guided needle biopsy and/or aspiration is especially suitable for granulomas that are close to the chest wall.
Over the years multiple criteria have been developed in attempts to distinguish whether or not a granuloma is cancer. These include, but are not limited to:
· absolute size,
· doubling time, the time it takes for the volume to double,
· calcified or non-calcified,
· degree of density,
· frequency of such granulomas, often due to fungi, in the general population of certain regions, such as Histoplasmosis in the mid-west and Coccidiomycosis in the southwest of the US,
· smooth or irregular margins,
· smoking history, and
· person's age.
Here are some examples of application of the criteria. The size of this 11-millimeter (mm) granuloma falls into the category of small. The majority of small granulomas are not cancer. A minority of 20 to 40% of small granulomas is cancer. Although this is a minority, it is still a sizable portion. So size alone must not be the sole determinant. Rapid growth also favors not being cancer, such as doubling in volume in about 30 days.
The application of these criteria to a specific granuloma is a science best practiced by thoracic radiologists and also by pulmonologists. You should seek consultation with these specialists. Do not rely solely on the opinion of a thoracic surgeon. Bottom line -- do not rush to surgery, as recommended. Seek further consultation from both a pulmonologist and a thoracic radiologist.
If I had something in my lung that grew 3 mm in as many months, I would be seeking a very speedy second opinion...and getting a consult with the thoracic surgeon. Most laparoscopic procedures are very minimally invasive, and it is best to know what is going on. It sounds as if the growth will need to be removed regardless of it's cause if it plans on continuing at this rate. I don't know if you live near a large center like Cleveland Clinic or the like, but that is where I would go. There is a website that lists the Top Hospitals for each profession. Look there and find one close by.
I hope it turns out benign and that everything goes well for you. Hang in there and definitely get that second opinion...but do see the surgeon too.
The website is here:
http://www.usnews.com/usnews/health/best-hospitals/tophosp.htm
I hope your PET goes well tomorrow.
I've been dealing with granulomas of that size on both lungs for over a year now.