Granuloma From Pneumonia

[tbart]

I am a 36 year old male 25 lbs overweight and mostly out of shape.  I get seasonal allergic asthma in the spring and use a apap for sleep apnea.  Otherwise I am in good health with no other afflictions.  I am married and have three young children, the oldest in kindergarten.

In late July 2004 over the span of 12 hours I became very ill with a respiratory disorder.  I spent 6 days in the hospital, 4 in ICU with an unknown strain of (presumably) pneumonia.  I was on antibiotics for typical and atypical strains and recovered fairly quickly after discharge.  I spent two additional weeks resting before returning to work.  They never actually made a complete diagnosis; something I am told is not uncommon.

I went for a chest CT in early October to check the lungs.  The pneumonia cleared up but I have five spots in each of my lungs that my doctor believes are granuloma.  She recommends that we repeat the CT in 6-8 weeks and hope that the granuloma have disappeared.  She states that if they are still present, or have enlarged I need to see a lung specialist.

Is this the correct course of action?  My doctor is a general practitioner who does stints at the local community hospital.  I have access to the prestigious Boston medical centers.  Should I seek a second opinion?  Should I insist on seeing a lung specialist now?

[lovelyday87]

I read your problem and if I were you, I would be considering seeing a lung specialist immediately.  I am going through the same thing as we speak.  I started having chest pains a month ago, and I have had 2 lung cat scans which showed granulomas/nodules on both lungs which are very small.  Less than 1 cm and 1 cat scan of my heart and a stress test and I passed all of the test.  I was told it might be sarcoidosis, emphyhema, histoplasmosis.  Finally, after blood tests that were taken, I tested negative for everyhthing, except on my ANA test (antinuclear antibodies), I tested positive for it.  Which means I could have Lupus.  My lung specialist has now ordered me to have a biopsy, which I should've done to begin with so I wouldn't have to go through all of this anxiety, and a Rheumotogist to see if I have Lupus.  I wouldn't wait around to see a lung specialist.  The cat scans can only pick up so much.  Blood samples and urine samples need to be taken in order to dismiss other diseases and/or detect a disease, and a biospy will confirm it 100%.  I would skip everything and demand to see a lung specialist so he can refer you to a surgeon who can perform the biospy.

[National Jewish]

Your doctor's recommendation is reasonable.  These spots may be granulomas.  They may be a residual of the pneumonia that will eventually clear up on their own.  Medically it is appropriate to repeat the CT in 8 weeks, as long as you are not sick during this period of time.  However, if you are very anxious, you may want to ask to see a lung specialist earlier.

Another option is to read the original radiologist's report.  Maybe even talk directly with that radiologist.  A good radiologist will often be able to speculate on what these spots represent, with reasonable certainty.  If not, you could ask that another radiologist look at your x-rays and CT scan.  Ideally this would be a radiologist who specializes in pulmonary radiology.

[tbart]

Thought it might be worth pointing out that while hospitalized my sputum was bright yellow (like egg yolk).  None of the doctors had ever seen that before...