Nodules Spreading in Lungs

[Mattp618]

In 2001 a regular chest X-Ray detected calcifications in my lungs together with enlarged lymph nodes (I don't know if the lymph nodes were in my lungs or the airway leading to the lungs.  Two years of CT scans followed and no change was detected.  Since I had not experienced any adverse affects and things seemed stable I was told to follow up with annual chest X-Rays to look for evidence of things changing.  

A few months ago an X-Ray at an annual checkup showed some change.  What they are now calling nodules are spreading somewhat.  CT scans followed to confirm this.  A bronchoscopy was done so they could see the nodules and take some scrapings of some sort.  All test results came back negative.  My pulmonologist recommended that I have lung surgery to remove the largest nodule so they could biopsy it.  Apparently a needle biopsy is not an option because the desired nodule is close to an artery/vein so it could be risky and perhaps not enough of the fungus suspected to be at the center of the nodule might be obtained to make a good diagnosis.

As I mentioned a fungus is what is suspected.  I was asked if I ever lived in Arizona or the Southwest.  I did reside in Ft Huachuca, AZ for 6 months for military intelligence officer training.  I did a little research and I'm guessing the doctor is thinking I might have Vally Fever (Coccidioidomycosis).

I got a second opinion.  He pretty much said the same thing.  He asked if I lived in the Southwest or if I had ever been caving in Tennessee.  I'm two for two.  I lived in Tennessee in high school and did a lot of caving, but most of it was in east Tennessee.  The doctor said the Tennessee fungus was found more in west Tennessee.  

So...after two pulmonologists in Atlanta recommending I have lung surgery to get a sample nodule I'm scheduled for surgery on 11/13.  The surgeon will do a thoracoscopy with a camera and two surgical devices that can cut out the nodule.  The surgery is purely for diagnostic reasons.

While the surgery sounds as noninvasive as lung surgery could be, it is nonetheless lung surgery.  From what I understand the body encapsulates a fungus it cannot destroy.  So I guess in order to make the correct diagnosis you need to get cut open one of the nodules to figure out what's in there.  Only then can you determine what treatment to use.  I have heard that the antifungal agents can themselves be problematic.  Sounds like you wouldn't want to use the wrong one.

I'm a healthy, active 46 year-old man who plays singles and doubles tennis three times a week and can keep up with my 6 and 9 yerar-old boys.  I have no symptoms at all that I am aware of other than these nodules seen through the miracle of modern science.  

My questions are "Am I doing the right thing?", "Is there a less invasive way to figure out what is going on?"  and "What can I expect if I do have a fungal infection like Valley Fever?"

Matt

[maggiemag]

Is the biopsy going to change your treatment at all?  I think I would get yet another opinion from a different group of pulmos.  It is an invasive procedure and you don't want to be just an academic exercise.  It sounds like they just want to narrow down the exact type of fungus, and that's all.

[Mattp618]

Apparently not enough information could be received from the bronchoscopy to determine what is causing the nodules.  Both pulmonologists in different practices and totally unconnected to one another agreed that the only way to know how to treat the problem is to get one of the nodules out and a needle biopsy was not an option.  So you are right, the surgery is for diagnostic purposes only.  Not fun to think about.  But apparently the anti-fungal agents can have significant side effects or be otherwise problematic and to treat with the wrong one could be a bad thing.

Matt

[Anant10]

Hi Matt, your apprehension for the surgical removal of a nodule for diagnostic purpose is very understandable. Just let me know, if during broncoscopy, bronchial lavage was done or not? Also, if lavage was done, was it sent for fungal culture?

[Mattp618]

I'm unsure about the types of testing that was done.  I know that all tests came back negative.  I know that some of them required cultures that I'm thinking took a while to grow.  Other than that I can't tell you anything much.  I'm out of town and don't have all my paperwork that might tell me more.  I'm going back tomorrow morning though.  Maybe there will be some info there regarding what was done.  

Right now I'm pretty much moving forward with the surgery I guess.  It is scheduled for Tuesday morning.  I saw another posting here by whatever doctor/RN answers these things and they seemed to be telling somebody in a similiar circumstance that surgery was the right move.  I'm guessing the same applies here.  

The surgery is going to be one incision where a camera with a light will be inserted.  Two others will be for utensils that I think will be used like chopsticks to cut out a small pizza wedge that contains the nodule.  I'm not looking forward to it, but if it will help figure out what's going on then maybe it is the right move.  I've had two doctors in different practices say the same thing.  I'm just wondering though if the experts at the Jewish center in Denver would have other thoughts on the subject.  

Matt

[Mattp618]

I went ahead with the surgery and got the largest nodule and a row of 3 other nodules removed yesterday and they sent me home the today.  A quick in and out.  I'm still on some pain medicine but otherwise doing fine.  They say I should know what the nodules are in 4-5 days and they are running cultures that will take 4-6 weeks to cultivate (don't know if that is the right word).  I'll let you know what happens.  I thought that at some point I would've heard from a doctor or RN here, but I don't know how what their turnaround time is and I didn't have a lot of time to spare.  Once my doctor comes up with a proposed course of action, I'll try to see what people here say.

Thanks for your responses.  Not only mine, but your responses to others as well.  You seem pretty knowledgable.  

Matt

[joey6]

Hi i hope everything goes great i would like to hear how it goes i posted a simalar post i have several uncalcified nodules in both lungs one 8mm and several small nodules been ct scanning for two years at the mayo in minnesota the last ct two weeks ago showed no growth on all nodules except now a new one showed up my doctor thinks there  histoplasmosis found frequently around this area he wants to scan again in 6 months did your orginal ones stay the same size and then new ones showed up.  Joey

[Mattp618]

I went through 2 years of CT scans and nothing changed.  At that point I was told to do annual chest X-Rays to look for any change.  After 6 years or so suddenly there were more of the nodules.  I'm not sure if mine grew bigger or simply spread to new areas.  I'll see if I can find out when I visit my surgeon again next Wednesday.  Good luck with everything.

Matt

[joey6]

Hi Matt how did you come out on the doctor visit

[Mattp618]

I had a follow-up meeting with my surgeon.  He provided me with a lab report that showed that the nodules did not contain a fungs as they expected, but rather appeared to contain something like talc.  I asked him if I could have gotten it from spackling and sanding walls while preparing them for painting.  I did a bit of that over the past year, but used a mask most of the time.  I may not have done so for all minor touch-ups though, but certainly tried to refrain from breathing when I sanded.  He said that he didn't think that was it.  He said they were still running some fungal cultures and wouldn't know the results from those for another 4 weeks or so, but he thought talc was the problem and there was nothing else to do but monitor my lungs with X-rays during my annual physicals.  I hope it is that simple!  

A few days later I looked at the ingredients of spackling online and one of the ingredients is talc!  I'll schedule a follow-up meeting with my pulmonologist after the cultures are done and take in the spackling I used.  I'll ask him his thoughts on the spackling/nodule connection.  My exposure to the stuff has been fairly limited.  If that is what is causing this I can't imagine what the lungs of people who work with this stuff day in and day out look like?!!

I hope everything works out for you.  Based upon my limited research it seems that the Mayo in MN is pretty good.  Hopefully you are in good hands.  

Matt