subpleural pulmonary nodules & kidney cancer

My father-in-law recently had ultrasound followed by two CT scans.  The diagnosis of kidney cancer is fairly certain but we are getting mixed messages about nodules found on his rt lung. The radiology report quotes "findings concerning with pulmonary metastatic disease".  The urologist that dx the kidney cancer (12 x 9 x 7 cm mass) states that he and radiologist are not so concerned about a 7x8 mm nodule in the right posterior superior lobe along with several other "tiny" 3mm nodules.

Father-in-law next visit is June 10 for consult on the kidney.  This is in a rural area of NC and we are wondering if a second opinion is recommended.  We live in the Raleigh area and have access to Duke and UNC.  Any input is appreciated.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
There is a possibility that the pulmonary nodules could represent metastasis from the renal cancer.  The other possibility is that they could be infective. In a known cancer patient, presence of multiple subpleural pulmonary nodules is highly suspicious for metastatic cancer. A PET scan may be helpful in the diagnosis.
You may like to consider requesting an earlier appointment. Patients treated in high volume and academic centres have been shown in some studies to have better outcomes.
All the best, and God Bless!