Multiple Pulmonary Nodules

[afwah]

My father, 86, complained a chest pain in November 2004.  A x-ray was taken on November 23, 2004, but showed a clear lung.  On December 31, 2004, he got an acute onset of hoarseness and suffered also from a sore throat.  He felt a mild degree of shortness of breath and produced yellow sputum.  Another x-ray was taken on January 3, 2005.  This time, a lesion of 3cm in diameter was observed at his right lung base, together with a number of round nodules appearing on both lung fields.  The radiologist also reported pleural effusion, emphysema, airway obstruction, and secondary pneumonitis.  However, his hilar was normal.  He, who did not have the previous x-ray for comparison, suggested that the findings were likely due to right lung cancer.  On January 6, 2005, a contrast-enhanced CT was done to my father.  A 38 x 37 x 42 mm lobulated mild contrast enhancing tumor, with non-enhancing and calcified internal area, was noted.  Adjacent pleural reactions were also identified.  Similarly, numerous few mm to 20mm round nodules were reported.  In addition, mediastinal lymph nodes were found to enlarge.  No pleural effusion was observed at this time.  All other findings were normal.  The radiologist concluded that the results were more likely due to right lung cancer.  He staged my father¡¦s case as T2N3M1.  My father visited an oncologist on January 18, 2005.  He said that my father was too old to do the invasive tests and then administered the treatment using IRESSA.  On February 15, 2005, another x-ray was taken showing no improvement.  Should the case be an acute inflammation?

[National Jewish]

The chest x-ray of November 23, 2004 was clear.  Then the lesion and nodules showed up on the chest x-ray of January 3, 2005.  This means that they developed over a period of 6 weeks.  Small cell cancer of the lung has the most rapid doubling time, a mean of 2 months.  This does not sound like primary lung tumors because of the rapid appearance and growth.  The findings are more likely to be due to an infection.  They could also be due to cancer that has spread from a very rapidly growing tumor in some other area of your father’s body.

It is important to establish a diagnosis, especially if your 86-year-old father was otherwise vigorous and enjoying life prior to the onset of this illness.  Only then is it possible to determine if he needs to be treated for cancer, an infection, or end-of-life care.  I strongly suggest that you get a second opinion from a pulmonologist.  You need to find a lung specialist who is willing to do a modestly invasive test to find the problem.  One such test is a transthoracic needle aspiration or biopsy.

[sueb1230]

A related discussion, 2 pulmonary nodules was started.