What could this right lower lobe mass be, if not cancer?

[ouisie]

My 78 yo father developed hemoptysis for 1 1/2 weeks in early January, after a severe 4 hour nose bleed.  Hemoptysis occured for 1 week when he quit smoking in 10/07 (1 ppd x 60 yrs). A chest CT 1/8/08 identified a 5cm x 3.5 cm right lower lung mass and 2 enlarged mediastinal lymph nodes.  A PET scan 1/15/08 was inconclusive.  No glucose marker uptake in the lymph nodes & only a 1.7 SUV ringlike uptake around the RLL mass.   A lung biopsy 1/22/08 showed no malignant cells, but only blood was obtained with 2 samples taken at a CT guided lung biopsy.  What else could this mass be, if it's not cancer?  A bronchoscopy & mediastinoscopy are the next planned procedures.  FYI, my father has atrial fibrillation & takes coumadin.

[ouisie]

My father has had some shortness of breath w/ activity & prefers to sleep in a recliner.  He only had pain in his right lower rib x 2 days (just a few days before the CT scan that showed the mass).   His pulmonary functions tests are 50% of normal.  He also has mild to moderate pulmonary hypertension per his echocardiogram.
My father underwent a bronchoscopy & medistinoscopy w/ biopsy of 6 lymph nodes yesterday.  The lymph nodes are benign & no malignancy has been detected in the bronchial washings thus far.  Cultures will be known by next week.
Is a "lung bleed" a possibility?  Why would this occur w/ no known injury?  Could the pulmonary hypertension & coumadin usage cause this?  He needs to be on anticoagulants due to his atrial fibrillation/stroke risk.

[HeinrikMD]

Hi,
The size of the mass is pretty hard to miss on an Xray, it would be pretty unlikely for cancer to grow to such a size within a month. I do agree however, with the plan to do the bronchoscopy to make sure.

It would be important to look for an infectious cause, the bronchoscopy would also help obtaining samples to check if microorganisms are present. There are also benign masses that may be found, the biopsy could have showed if this was the case.

could it be possible that all the bleeding is due to the coumadin? without the bleeding, are there other symptoms associated with the lung such as shortness of breath, painful breathing.

[ouisie]

I forgot to mention, my father was in the ED with bronchitis in 10/07, but had no antibiotics, just a course of prednisone & inhalers.  No other known respiratory infections.  The pulmonologist, oncologist & thoracic surgeon all think it's odd how round & smooth the mass appears on xrays.  This mass was NOT there on a 12/8/07 CXR. (Our area is fortunate to have lung clinic to navigate regional chest mass patients through diagnostic testing & consults).