Lung nodules

[terong]

Hi, how's it going?
Thanks so much for your help in advance.

Here's a brief story of my problem: I am a 27 year old male and had a TB skin test almost 3 years ago and it was positive, but I did nothing.  Then I was going to get another TB test in August this year and I told them about the test I had 3 years ago.  They said if it's positive, it will always be, so I didn't get another skin test.  Rather, they only did an x-ray.  It showed 2 thin nodules, 1 on each side.  At that time, they could barely be seen and I was sent to a lung specialist.  I had a blood test too to check on fungus infection and it came back positive.  I've just moved from Arizona and they said there's a certain fungus there.  So, the doctor was not sure about what caused the nodules. I then started taking TB medicines since the only sure thing is the positive TB skin test.  I follow up the x-ray every month and in Sept, the x-ray doesn't show much difference I then had a biopsy to find out exactly what is wrong.  The biopsy didn't reveal anything, or everything is negative. So, I stopped taking 3 TB medicines but only 1 instead, for the TB infection.  However, I got another x-ray in late Oct and they both got more dense and still insignificant difference in size.  I lately also  feel way more uncomfortable sensations (movement and slight pain) than last week and they last longer too.  I feel more and more of them as time goes by and they are in random places in both lungs.  They are mostly around the middle of the lungs and below. I am going to see the doctor again next Monday.

However, I have been absolutely HEALTHY and having no problems at all, such as weight loss, shortness of breath, coughing, etc, since the nodule discovery, and before.

I realize it's puzzling.  Do you have any idea?
Thanks again, I really appreciate your help.

Sincerely,
Tom

[National Jewish]

The nodules are probably unrelated to the positive tuberculosis (TB) skin test (PPD).  You should continue with the one TB medicine for a total of 6 months.

Lung biopsy is a procedure where a tube called a bronchoscope is passed through your nose into your windpipe to look into your lungs.  With the bronchoscope tiny pieces of lung tissue can be taken for further testing.  When nodules are small, it is possible that the lung tissue taken by biopsy is from an area of normal lung rather than the nodules.  This lung tissue will of course be normal and not tell anything about the nature of the nodules.

A nodule is usually a small, round shadow seen on chest x-ray anywhere in the lungs.  Nodules are due to infections, inflammation, or tumors.  Small nodules in a healthy 27-year-old male are almost certainly benign.  As long as these nodules do not change in size, they would be of no concern.  Nodules are common in certain parts of the United States.  Fungal infections are a common cause of nodules in the southwest due to Coccidioidomycosis also called valley fever.  These are also of no concern.  As long as there is no calcification of the nodules, their increased density is a strong indicator of their being benign.

The chest discomfort is probably unrelated to the x-ray findings.  This needs to be assessed directly, by your doctor.  The best choice at this time is to carefully monitor these nodules for no less than one year.  They will be watched for a change in size and configuration.

[terong]

Today the some discomfort/slight pain last for few minutes and there's movement twice around the nodule; quick movement just like when we sometimes have it in any parts of our body.

Something is very wrong here.
Help plz...

[terong]

Also, sometimes when the discomfort is there and I take a deep breath, it intensifies.  I cannot describe exactly what it is like.  May be, like something is stuck in the lung.

What diseases can cause such weird symptoms?

Thanks!

[terong]

The nodule size is around than 1 cm in diameter each.

Thanks...

[burchm634]

Hi,

I'm from Arizona, have lived here more than 25 yrs.  Have you been tested for Valley Fever?  It is also called: Cocci, San Joaquin Fever, Desert Fever, desert rheumatism and several other names.  The medical name for it is: Coccidiodomycosis.  From the medical dictionary, "It is an infectious fungal disease caused by the inhalation of spores of the bacterium Coccidiodes immitus, which is carried on windborne dust particles.  The disease is endemic in hot, dry regions in the SW.  Primary infection is characterized by symptoms resembling those of the common cold or flu.  Secondary infection, occurring after a period of remission and lasting fr wks to years, is marked by low-grade fever, anorexia and wt loss, cyanosis, dyspnea, hemoptysis, focal skin lesions resembling erythema nodosum, and arthritic pain in the bones and joints.  The diagnosis is made by learning that the patient was living in or visiting an endemic area and by identifying C. immitus in sputum, exudate or tissue.  Treatment usually consists of bedrest and the administration of antibiotics."   I have had valley fever for approx 1 yr.  Was extremely tired/wanted to sleep all the time.  This disease can result in nodules/scars on the lungs.  Is is possible this could be your problem?  Since you have moved to another part of the US, you may want to bring this to your doctor's attention to see if they would test you for this.  Animals even get this problem because they are always outside and being exposed to the dust/dirt.  A simple blood test can determine if it could be this problem.

[burchm634]

Another note:  Valley Fever is a fungus. The University of Arizona in Tucson has a Center of Valley Fever information.  You may want to have your doctor check with this center for more detailed information on this fungus/disease.  Doctors from other parts of the US may not be very familiar with it.  Contact University Health Center in Tucson for more info.

[burchm634]

More info on Valley Fever.  There are several good websites on Valley Fever.  You can search under the full medical name and also valley fever.  Both will net several websites for info resources.  www.ivillage.com and www.valleyfever.com.  Good luck!  There is much info out there on this disease.  And you will recover from it too!

[terong]

First of all, thanks for the comments!  I thought no 1 will ever answer me.  

My blood has been tested for Coccidiodomycosis and it came back positive.  However, I had a positive TB skin test too.  The doctors over here (MO) said that the blood test cannot be 100% correct.  As I mentioned, I had a biopsy too to  make sure what exactly caused the nodules, but everything came back negative.  They said may be the specimen taken (3 of them) did not contain whatever caused the nodule.  I just talked to the doctor yesterday and he basically said many things can cause a nodule and since the TB and Coccidiodomycosis tests are positive, he thinks a large percentage one of these two can be the reason even though the chance of getting TB at my age is small, but anything is possible.  So, he thinks the next step is to have a surgery to take a bigger portion of the nodule, or remove it so that they'll have good chances of finding out exactly what it is.  That really SUCKS!!  $2000 biopsy was wasted and now they're suggesting the last resort.  I did talk to them about going to Arizona to have it checked there, but they said, given the facts, they would say the same thing too and cannot determine the cause.  Do you think I can just call the University medical health center to ask about it?

It's important for you to know though that I have been feeling no symptoms you mentioned in your comment.  Did you feel any chest pain or movement in the chest?  That is all I am having and recently it's subsided.  How was the development of your nodules?  How many did you have and how big?  Did they get bigger or denser?  Mine for sure got more dense and negligible difference in size (about 1 cm in diameter) after 2-3 months of first discovery.

Thanks so much and I appreciate your help.

Terong

[terong]

I just don't want to go thru something like this:

http://www.arl.arizona.edu/vfce/wwwboard/messages/1696.html
"Posted by EH on May 27, 20102 at 08:00:18:

I moved to Phoenix in June 1999 and in late April/early May 2001 I started getting sick with intermittent spiking fevers. This was followed by serious cough and lung congestion. My Doc suspected VF but my blood tests came back negative, repeated times, for a period of almost a month. By this time I was seriously sick, fever after fever, etc. They finally put me in the hospital where my blood titers came back negative still. I had a bronchoscopy (lung washing) came back neg also. Bone marrow biopsy (ouch!) neg also. Finally they did an open lung biopsy, serious surgery, to collect a lung tissue sample. Finally, they got the positive VF confirmation. Four months of IV Ampho B (nasty!) and I feel great. Still taking the diflucan. My question is this: A doctor (friend) told me that the standard VF blood test they perform is pretty inadequate and that UC Berkley has a much better test that could have saved me the cost, pain and hassle of the lung surgery. Anyone know anything about this? "

What worries me is I have no such symptoms!  But I was given info about the fungus and some victims do not feel any symptoms at all.  I am perplexed now...

[burchm634]

Hi again,

First, I found some excellent websites on Valley Fever.  My general search was: University of Arizona Valley Fever Center and it brought up many sites.  There is a VF hotline, 520 629-4777, and a email address where you or a doctor can contact them directly, ***@****.  Please search and find every single scrap of info to educate yourself about this disease.  Yes, it can have no symptoms at all.  Another excellent website, which I found extremely informative, and written by a patient: http://members.tripod.com/~B_u_d/vf,htm.  Keep searching and you will find all the info you need.  Ask your doctors to call UA Valley Fever Ctr directly.  There is also medical info for doctors on this website:  www.arl.arizona.edu.

[terong]

Yeah!  Thanks so much!
Now I want who I should talk to.  
I am trying to plan on giving John Gigliani a visit at the UofA.
I've sent an email to the center and gotten back their answer.  I am very satisfied and pretty sure that it is VF.

[burchm634]

I should tell you of my own experience with Valley Fever.  I moved from WI to AZ in Aug 1975.  We lived on a dirt road; therefore, there was always dust/dirt & windy conditions.  By Nov 1976 I had contracted VF.  Usually people who have never lived in such an area pick up VF not too long after moving to that area.  My son was about 2 1/2 yrs old & I started being very tired.  So extremely tired that I after I got up in the morning, I wanted to go back to bed--for the day!  I have always had lots of energy & for a young person, this was quite unusual.  This extreme tiredness went on for approx 1 yr. (Of course, I had been diagnosed and rec'd regular med care/with x-rays every single month to see exactly which stage & where the nodules were on my chest.  They did not have a serum or any meds in 1976 to fight this disease, as they do now.  After about a yr, I started to feel better.  It took me approx 2 yrs after that to completely regain my original energy levels.  Through the yrs & because I had it quite severely, I have had many lung infections/bronchitis.  This has weakened my system & now it is easy to pick up any cold--6-7 times/yr.  Drs fight bronchitis with antibiotics every single time.  In addition, I have had many problems with allergies over the yrs.  In 1997 I began allergy shots/2 shots/once a wk for 5 1/2 yrs.  That was the very best thing I have ever done for myself!  Since then, I am bothered with allergy problems some, but very little really.  The allergy shots/immunotherapy as it is called/have helped greatly to control my lung problems.  However, I now have problems with asthma/wheezing, but that too, is under control most of the time, unless I get another infection.  I do not have limitations with any activities, but I do try to protect my health, taking flu shots every yr/took a pneumonia shot, generally trying to take good care of myself.  I always try to protect my chest area and not get chilled, which always leads to another infection.  I did not have the disseminated kind of VF, but I did have it quite severely.  Many people have VF so mildly that they do not even know they have it.  The symptoms that I had were:  extreme fatigue, a slight red rash, some cough and phlegm/sputum, and a continuous low-grade fever.  I can't tell you how glad I was to begin feeling better.  That is really it.  What you should know though, is that VF can be very serious, so you need to seek help for it ASAP.  Basically, I have compromised lungs like a smokers lungs, except that I have never smoked in my life! This is my experience & how VF affected me.  Hope you get help and feel better soon.