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Lung Nodule
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Lung Nodule

Hi,

I have been experiencing coughing for the last three months. It is not constant all day and it is not very intense. I also had some abdominal discomfort, night sweats, and fever for about a month when this started, but they are gone now except for coughing.  It is not so bad and only happens during the day. It is not an intense or constant coughing, but rather happens when I am breathing out. I had a complete workup for the last three monhts that included, colonoscopy, endoscopy, capsule endoscopy, abdominal ct etc. They were all negative. Complete blood work which was all normal. I also had two echocardiogram which was basically normal.

But I also had a CT of my chest last week and it showed two small nodules.  One is in the right middle lobe measuring 2 to 3 mm. This was also seen in another chest CT in December  2008 has not significantly changed since then.  However, the other nodule is new.  Here is what the report says:  

"There is a small irregular nodule measuring less than 5 mm in the upper right lobe which is not identified on the prior study.  Another small nodule in the right middle lobe measuring 2 to 3 mm which has not changed significantly since the prior study. There are no other nodules. There is no pericardial or pleural effusion and no adenopathy.
The mediastinal vascular structures and cardiac chambers are normal. The upper abdominal structures are normal.  Bony structural are intact."

I am a 38 year old white male and have never smoked in my life.  There is no cancer in my immediate family.  

My doctor wants me to follow up with another CT in six months.  

I would like to get your insights.  

Thanks.

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Greetings,

I agree with your doctor’s recommendation, that the CT Scan be repeated in 6 months, with one caveat.  The reasons for agreeing are: your young age, the small size of the new nodule (this is a very small nodule), your history of never having smoked cigarettes and the absence of a family history of lung cancer.  

The caveat is that one of the features of a malignant nodule is that the nodule be “irregular or speculated”.   Irregularity is, however, of much greater import with larger nodules than with a 2-3 mm nodule, in which instance irregularity is usually barely perceptible and, thus, a less reliable sign of malignancy.  In essence, the probability is high that this new nodule is benign, but not 100%.  

Incidently, it is highly unlikely that the new nodule has any relationship to your recent cough, with the exception that, if you had pneumonia, the new nodule could be a residual of the resolving pneumonia; i.e., a part of the healing process.  And, this would be one more reason to defer judgment and repeat the CT Scan, as recommended by your doctor.  The odds, that this new nodule is of no consequence, are highly in your favor.

One final thought.  You might wish to ask your doctor if the radiology technique was the same for the 2008 and the recent CT Scan.  If not, might the presumably new nodule been present but not visible on the initial scan?

I hope this helps.

Good luck
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