Lung abscess

I have had a constant cough. In the mornings I cough up bloody sputum. My doc did a ct scan finding a 2 by 3 cm lesion in my lower lobe of my lung. Biopsy showed just a collection of inflammatory cells. He wants to "watch" lesion. No meds, no treatment even though I'm exhausted, short of breath and coughing up blood daily. I have had a thoracotomy on my right lung for the same thing 12 years ago. The abscess grew and ruptured, and emergency surgery followed. Why is my doc waiting and doing nothing with my history? He tells me sometimes the body "self heals" these lesions. Please advise.

[David Tinkelman, M.D.]

The “collection of inflammatory cells” may well be necrotic material in the center of this undiagnosed mass.  That finding must be considered non-diagnostic and certainly not an indicator of a benign lesion that will “self-heal”.  That, the size of the lesion and the persistence of bloody sputum demands further diagnostic efforts, without further delay.

It would be most important to confirm that the material obtained was examined for malignant cells and infectious organisms including TB and fungi.  If this testing was not done, further material could be obtained, for example by bronchoscopy or needle aspiration and submitted to the lab for testing.  But, with the first “biopsy” having been non-diagnostic, it might not be a good idea to accept further delay

My concern is that the continuance of haemoptysis (bloody sputum) speaks to a greater urgency to establish a diagnosis.  Your continuing to cough up blood on a daily basis raises the risk that you could suddenly have an episode of sudden massive bleeding that could be life-threatening.

Another minimally invasive technique that would accomplish that is called Video-assisted thoracic surgery (VATS).

My advice is that you decline the advice of your physician to await self-healing and request consultation with a lung specialist (pulmonologist) without further delay.

Should surgery be recommended be sure to raise the question of whether this lesion could be what is called Sequestration of the Lung, a condition that if not recognized prior to surgery could result in very serious complications.

Do not wait any longer and do not worry about hurt feelings as a result of your rejecting your physician’s advice.  You need to get this resolved quickly.  Feel free to share this message with your doctors.  Please let us know how this works out for you.

Good  luck.