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Ct Scan shows 11 mm granuloma
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Ct Scan shows 11 mm granuloma

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
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251132_tn?1198082422
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:  
9 Comments
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61536_tn?1340701763
This forum offers a ridiculous wait time for an answer.

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
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Avatar_n_tn
Get a PET scan immediately.  Don't take no for an answer.
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Avatar_n_tn
Thank you both, I have a PET scan scheduled tommorrow, and if needed surgury on the 22nd
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61536_tn?1340701763
Keep us updated...

I hope your PET goes well tomorrow.
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Avatar_n_tn
Is the PET scan that definitive? I won't know the results until next tuesday, but what if it shows no cancerous activity in the lung spot, would I be safe to cancel the surgery????
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Avatar_n_tn
Follow up on my PET scan. Good news, the PET scan came back negative. I am still not out of the woods because they seem to be accurate in detecting cancer metabolic activity in tumors over 6-7 mm, my spot is 11 mm about 1/2 inch, so there is still some question. I am switching surgeons to one recommended by our trusted friend and oncologist. I see him on Thursday, most likely he will recommend a needle biopsy. The other one wanted to take the whole thing, pays to look around. I am feeling good about it, still a few questions to answer, but things seem better
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Avatar_n_tn
How did this turn out?

I've been dealing with granulomas of that size on both lungs for over a year now.
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Avatar_n_tn
I had the surgery about 2 weeks ago, everything went fine, they used a VAT technique and removed the spot it was not maligmant. Recovery is not bad, still a little sore
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