Multiple Lung Nodules, Pneumonia, Sweats, Minor Atelectasis

[nuttijo]

2 weeks ago I was hospitalized for 6 days for treatment of a bacterial pnuemonia (pneumonia).  I had been ill already for 2 weeks.  For several months I've been complaining of shortness of breath, wheezing and productive cough (yellowish gray mucous with brown and black streaks), nasal congestion (which is bloody everytime I blow my nose) and pain in my left shoulder blade.  During my hospitalization, chest x-ray showed granulomas in the left mid lung, minor atelectasis in lower lung, mild apical scarring bilaterally and compression of the T7 vertebral body.  A CT scan was then done which showed multiple lung nodules in the left lung (a total of 7, the smallest measuring 5mm and the largest 8mm), a shadow in the upper left lung which they said was probably the pnuemonia (pneumonia), atelectasis and mild apical scarring.  Since my discharge, I have been using a nebulizer 4 times per day to help with my breathing (with Atrovent).  I continue to have all prior symptoms, but my sweating is becoming severe.  I have never had this type of sweating.  I am 48 years old...had a total hystorectomy when 23 due to a diseased uterus.  I was diagnosed with gastroparesis last year and am being continously treated for this too.  I am weak and tired all the time.   I am scheduled for a MRI tomorrow.  My mother is concerned (she was a RN all her life) and says I could have TB or maybe something even worse.  I'm trying not to panic, but would like  a direction to take with my physician.  Everyone tells me the nodules are too small to be anything. Any comments would be GREATLY appreciated.

[National Jewish]

It is not possible to tell if you have tuberculosis (TB) just from a chest x-ray or CT scan.  When something unusual is seen the chest x-ray more testing is needed.  To find out if you have TB, your doctor will gather 5 important pieces of information:
· your symptoms;
· your exposure to TB compared to the start of your symptoms;
· the results of a tuberculin skin test called purified protein derivative (PPD);
· how your chest x-ray looks; and
· sputum test to see what germs are found.
Please read our Tuberculosis MedFact at http://www.nationaljewish.org/medfacts/tuberculosis.html for more detailed information.

You should keep a written record of your temperature that you measure with a thermometer along with your sweats.  Gastroparesis often occurs with diabetes.  Diabetes can make a person more likely to have unusual types of pneumonia.  An infectious disease specialist would be the type of specialist to determine your problem and the best treatment.

Pneumonia is inflammation of the lung.  This is most commonly due to an infection.  Treatment is based on the severity of your symptoms and the type of germ causing the infection.  Symptoms may include cough, chest pain, rapid breathing, shortness of breath, fever, chills, sweats, headache, weakness, tiredness, and a general feeling of discomfort and body aches.  It is generally best diagnosed by chest x-ray in addition to a thorough examination.

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.  Since the nodules are less than 1 centimeter in size they are very unlikely to be cancer.  A chest CT scan is usually the next test that is done because it is more sensitive and shows more detail than a chest x-ray.  The shape, smoothness, and density of the nodule will be seen on the CT scan.  This will help in determining what this could be.  If you have had previous chest x-rays or CT scans it would be helpful to locate them.  Then your doctor could compare them with your most recent chest x-ray and CT scan.  The comparison could be most helpful to your doctors, in interpreting these findings and the significance of the nodules.  The MRI will also be helpful.

A nodule must not change for 2 years to be considered stable.  A nodule that will eventually grow may be stable for 6 months.  So it is appropriate to repeat the CT scan in 6 months, again in another 6 months, and then, if no change is seen repeating the CT scan 2 years from when the nodules were first discovered.

Atelectasis is an area of the lung that is not receiving air.  This is often referred to as a collapsed area of the lung.  Generally this is due to something blocking the airway in that area of the lung.  This could be due to your recent pneumonia.

[nuttijo]

Just an update...after posting my original comment, my primary physician did a TB test which was negative.  My cardiologist has since contacted me regarding my lung scan and will be referring me to a pulmonary doctor.  According to my cardiologist, the results are consistent with "bronchogenic carcinoma".  I was very upset considering your site's response that nodules less than 1 cm in size are very unlikely to be cancerous.  My PFT tests were very concerning along with the atelectasis in the lower lobes of both lungs.  He said that since there were "multiple lung nodules" and these most definitely had not been on prior scans that we needed to immediately be seen by a pulmonary doctor.  A referral to a specialist is in the works.  I would recommend that anyone with an abnormal scan and x-ray pursue further follow-up on any nodules seen in the lung.  According to my cardiologist, these are not to be taken lightly.  If you look at the response given by this site on anyone questioning small lung nodules, the response is the same word for word!

[cheryld42]

A related discussion, Nodules was started.