dark spots on lungs after CT scan

[milaval]

My husband has been coughing for over 3 months.  at first, he was prescribed albuterol and antibiotics, and X-Ray did not show anything.  antibiotics helped somewhat, but then the cough came back and it's getting worth, and he has difficulty catching his breath after a moderate physical exertion. He coughs out large pieces of dence green mucus, sometimes with particles of blood in it.  he went to the doctor today again and insisted on other tests.  he had a CT scan and was also prescribed Q-Var. the dr. called him back today and said that CT scan showed 2 spots on his lungs of 4 mm and 14 mm.  she said not to worry and to repeat CT scan in 3 months.  of course, 'not to worry' part does not work.  so i would like to know what are the other things we can do meanwhile.  he is almost 50 y.o., non-smoker, healthy, but works as a car mechanic in an auto bodyshop, so he is exposed to metal dust, paint fumes, etc.  There is no family history of lung cancer.  thank you.

[David Tinkelman, M.D.]

Two spots on his lungs of 4mm and 14mm might not be worrisome as an incidental finding in a seemingly healthy man with no history of cigarette smoking but, occurring as they do in association with a (presumably) new onset chronic cough productive of “dense green mucous, with particles of blood”, they are a cause for concern and warrant further investigation.  Comparison of his current Chest X-ray and the CT Scan with chest X-rays 6 months ago or longer could enable his doctors to put the current “spots” in perspective.  The “spots” could be benign and perhaps related to his occupation but they could also be a reflection of infection or some type of tumor.

I suggest that you and his doctor request consultation with a lung specialist (Pulmonologist) now, rather than in 3 months, who may deem it appropriate to perform bronchoscopic examination of your husband’s lungs and/or biopsy the larger of the two nodules.

Good luck

[milaval]

Dear Dr. Tinkelman,
so, we finally received a formal letter describing results of the CT scan and, although, my husband's doctor explained the gist of it, there are things that she did not explain but that seem worrisome to me.  can someone explain in laymen terms what this letter is saying:
Mediastinum shows a few normal appearing subcentimeter mediastinal lumph nodes, including 8 mm right lower paratracheal lymph node, 6 mm subcarinal lymph node 6 mm prevascular lymph node.  there is also a right hilar soft tissue density measuring up to 14 mm in short axis, probably an enlarged lymph node, however other etiology including focus of atelectasis not excluded.  no pleural effusion, pneumothorax, or paracardial effusion.  heart size normal.  there is minimal linear atelectasis or scarring in the right lower lobe anteriorly/superiorly.  there is a 4 mm subpleural subtle nodule in the right lower lobe posteriorly on image 29 of series 2.  there is a 4 mm subpleural nodule in the left upper lobe posteriorly on image 11 of series 2.  there is a small focus of pleural thickening in the left lower lobe superior segment posteriorly, measures at least 3.5 cm in length, roughly 5 mm in width.  there is a minimal bronchial wall thickening seen bilaterally and minimal dependent atelectasis bilaterally in the lower lobes.  
Imperssion: several nonspecific finding seen in the chest, including right hilar soft tissue density measuring 14 nn as described above, 2 nonspecific 4 mm subpleural pulmonary nodules, and a focus of pleural thickening in the left lower lobe superior segment.

Although we, kind of, understand what it says, we do not understand what exactly it means and how serious (or not) it is.
thank you so very much!

[milaval]

Thank you, Dr. Tinkelman!