CT scan of chest

[debidol]

Hello,
Please help me in understanding the CT scan.
Pt. 48yr. pass smoker quit 25 yrs. ago.
Been sick since July 05, with ear infection, loose stools, cough w/wheezing, fever on and off. Better now except for a dry cough.
Dr. stated viral bronchitis poss. pneumonia
*XRay Chest; Subsegmental atelectasis in R middle lobe.
Asymmetrical prominence of the R hilum.
*CT scan impression; Pleural-based 2.0cm nodule seen in the superior segment of the R lower lobe abutting the pleura with spiculated margins.
Equivocal right hilar intrapulmonary ipsilateral lymph nodes seen.

Please help me in understanding impressions.
Thank you so very much.

[pasqually]

A related discussion, what does this mean was started.

[LACR]

I am a 32yr old female who has never smoked (but was near the WTC on 9/11 even after they collapsed)& have been sick on & off for about a month w/ a dry cough & I sound like a seal at times. I was diagnosed w/ bronchitis.(I have a history of getting it every yr & have had it 3x this yr alone) I was sent for an xray that came back showing a bulge in my diaphragm. then sent for a spiral catscan & the final impression is: "a 6mm pleural-based nodule in the left lower lobe; a few prominent mediastinal lymph nodes - probably reactive nodes; a focal bulge of the left hemidiaphragm due to mild eventration of the left lobe of the liver." I have an appt w/ a surgeon this coming wed. but just wondering if anyone knew what to make of these results. I'm very scared but have read that most nodules this small are not cancerous. any input would help!

[National Jewish]

The pleural-based nodule may or may not be related to your recent illness.  The same can be said, even more so, of the "subsegmental atelectasis in R middle lobe."  Atelectasis is an area of the lung that is not fully expanded.  This is often referred to as a collapsed area of the lung.  So the peripheral area of the right middle lobe (RML) of your lung is collapsed.  Generally this is due to something blocking the airway in that part of the lung.  This could be due to your recent bronchitis.  The nodule and the RML collapse may or may not be related.

Spiculation occurs on the edges of a nodule.  It refers to an irregularity of the surface.  The spicules project from the surface of the nodule like needles.  They look somewhat like the tiny thorns of a rose bush.  Such nodules may or may not be cancer.  In general nodules that are not cancer have smooth edges and nodules that are cancer have irregular edges.  However this association is not always the case.

It cannot be a determined with any certainty whether a nodule is or is not cancer based on this finding.  There are other characteristics of a nodule that suggest the likelihood of cancer.  Calcium makes a nodule denser and less likely to be cancer.  You should talk about this with your doctor.

If the RML collapse persists you will probably have to have a bronchoscopy of your lungs.  CT scan or other radiology techniques cannot prove the nature of the nodule.  Therefore there is a strong likelihood that your doctors will appropriately recommend that it be surgically removed, regardless of the results of the bronchoscopy.

These are complicated decisions.  It is much better to talk about this with your doctor and/or a pulmonary specialist than to rely on the information provided here.

[HappyNeige]

You should consult your doctor about the CT findings.  If the size is 2 cm and the margin is spiculated, the likelihood for the spot to be cancer is high.  CT can only give you the description of the spot and not the nature of it, i.e. cancer vs. scar vs. infection.  You still need to have sampling of the spot by either a needle biopsy (with CT guidance) or surgical resection (either wedge resection or removal of the entire right lower lobe).

Your doctor may also suggest to have a PET scan done to look at the right hilar lymph node to see if it is 'active' or not.  This will affect what he/she will recommend in terms of further tests/procedures and treatment.

Now, I am only offering my opinion based on the information provided.  (And please do not take these views as substitutes for medical advice.  You still need to talk to your doctor.)  There are other things to be considered, for example, the patient's lung function (to see if he can tolerate lung removal if needed) and other coexisting diseases.  Again, talk to your doctor.  Hope this helps.

Good luck,
HappyNeige...