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Respiratory Disorders (Expert Forum)
lesion on the lung
Answered by
CO
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lesion on the lung
by montrealguy, Aug 31, 2009 04:42PM
5 years ago I had bronchitis; they did chest x-ray and found a lesion in the upper right lung. I went for CT scan Dr. said he wasn’t worried about the lesion. It was scaring from Pneumonia I had had in 02. June/09, my daughter had an "unverified" case of H1N1 and I developed a cough. I went to the hosp they put me on Tamiflu, did nose swab. No H1N1. Cough got worse by June 12 I was coughing with every breath. Back to hosp they did x-ray. Dr.confirmed that it wasn’t H1N1 but put me on Zythromax (5 day ) for mild pneumonia. Cough went away. On x-ray they noticed that the lesion I had in the upper right lung had gotten slightly larger. Iin 04/05 it was about 1cm, and now it was 1.5cm.Clinic did breathing tests and I was in the 96-106% range for all but one exhaling test which registered at 62%. Lower limit of test would be in the 80% range.Given that the lesion increased they ordered another CT. It will be done in the next 10 days. I asked can this be cancer? I don’t smoke don’t work in any hazardous work conditions,eat well, rarely drink. My Achilles heel is that I suffer from Chrones for the past 25 years and have been on prednisone for all 25 years.Dr. said she could not rule out cancer but if it was it was a slow growing cancer due to small increase in 5 years. She also scared the hell out of me saying; maybe this is a metastasized tumor from somewhere else.So I stripped down and told her to check whatever she needed to check "lymph nodes, prostate"she did a curse review but didn’t say much.So how typical is it for a 43 yr old, male, non smoker, eats well, isn’t overweight, doesn’t drink, to develop cancer in the lung? Can a lesion that may be caused by pneumonia get bigger over time with recurring chest colds, bronchitis? Due to my long use of steroids I have a lower immune system and as such get more frequent chest colds etc.If I had a lesion from pneumonia in 02, and I had a flare up of bronchitis/pneumonia in June, could it have scarred the same place again?
Doctor's Answer
by National Jewish Health, Sep 03, 2009 04:11PM
, Sep 03, 2009 04:11PMTo: montrealguy
Let me, first, address your question and then follow that with information from Dr. Robert Mason’s Textbook of Pulmonary Disease. Information that you can read and discuss with your pulmonary specialist, providing a basis for him/her to elaborate on the text.
“Given that the lesion increased they ordered another CT. It will be done in the next 10 days. I asked can this be cancer?”
Any enlarging lung nodule can be cancer but, given the second sentence of your (next) paragraph (“I don’t smoke …), your age and especially, the slow growth of the lesion, the odds are much in your favor that this lesion is benign. Such slow growth of malignant tumors can occur, but is rare.
“this is a metastasized tumor from somewhere else.”
Again, the growth issue. If the lesion is a metastatic lesion now, it was a metastatic lesion 5 years years ago and no metastatic lesion grows that slowly.
“Can a lesion that may be caused by pneumonia get bigger over time with recurring chest colds, bronchitis?”
It may enlarge but not secondary to chest colds or bronchitis
“If I had a lesion from pneumonia in 02, and I had a flare up of bronchitis/pneumonia in June, could it have scarred the same place again?”
That would be extremely unlikely, unless you have some abnormality of your bronchial tree that interferes with normal mucous drainage and could predispose to recurrence of pneumonia in the same place. When pneumonia recurs in the same place, the worry is that the bronchus could be blocked by a tumor. In those instances, the recurrence usually occurs within a 3-12 month (max) period. But no tumor, big enough to obstruct a bronchus would have otherwise remained silent for this long period of time
The following is from the textbook
A nodule that has not changed in size for at least 2 years is probably benign. Considerable amounts of data have been accumulated on the growth rates of benign and malignant masses. The measure of growth is the volume doubling time (not the doubling of the diameter). Benign lesions almost invariably have a doubling time of less than 1 month or more than 18 months, with the volume doubling time for most peripheral pulmonary carcinomas being between 1 and 18 months (median 3 months)
In up to 20% of instances, a "lung nodule" visible on chest radiographs actually represents an artifact, chest wall lesion, or pleural abnormality; in some cases, CT is essential to determine the true nature of the opacity.[36] CT can be useful to define the morphology of the SPN and suggest whether it is benign, likely malignant, or indeterminate, having neither benign nor malignant characteristics. In some patients, a specific diagnosis of lesions such as rounded atelectasis ( Fig. 20.35 ),[55] a mucous plug, or arteriovenous malformation can be made based on CT findings, indicating the benign nature of the lesion. Other CT appearances suggest the presence of malignancy.[56][57] These include a spiculated or irregular contour[56][57]; the presence of air bronchograms within the nodule, bubbly air collections ("pseudocavitation"), or cavities; and a diameter of more than 2 cm (see Fig. 20.34 ).[56] The presence of several patterns of calcification can indicate that the SPN is benign; "benign" patterns include diffuse, central, laminated, and "popcorn" calcification ( Fig. 20.36 ).[36][37] In about 30% of benign nodules, calcium invisible on plain radiographs can be seen on thin-section CT. Carcinomas may occasionally show calcification, often in an eccentric or stippled pattern. The presence of fat within an SPN, indicated by a low CT attenuation coefficient), strongly suggests the presence of hamartoma (a benign tumor)[36][39][58] or lipoid pneumonia; such nodules can be safely followed with serial radiographs.
Malignant tumors tend to show greater enhancement than benign nodules after the rapid injection of iodinated contrast material.[38][59][60][61] Because the degree of enhancement depends on the amount and rapidity of contrast infusion, it is important to use a consistent technique. Injection of 420 mg of iodine per kilogram (approximately 75 to 125 mL) at a rate of 2 mL/sec is commonly used, with thin-section CT scans through the nodule obtained before the infusion, 1 minute after the beginning of infusion, and at 1-minute intervals for an additional 3 minutes. Enhancement of 15 H or more occurs with malignancy, hamartoma, and some inflammatory lesions. Enhancement of less than 15 H almost always indicates a benign lesion, usually a granuloma. Therefore, whereas positive results (enhancement of 15 H or more at any time point during the study) are nonspecific, negative results are quite useful. This technique has been shown to have a sensitivity of 98% and a specificity of 58% in diagnosing carcinoma. More importantly, the negative predictive value of this technique is approximately 96%.[61] CT nodule enhancement studies are most appropriately used for patients who have indeterminate nodules (i.e., those without typical benign or malignant appearances). The use of positron emission tomographic imaging (see Chapter 21 ) has also been shown to be very useful for distinguishing benign from malignant nodules.[62]
Good luck
“Given that the lesion increased they ordered another CT. It will be done in the next 10 days. I asked can this be cancer?”
Any enlarging lung nodule can be cancer but, given the second sentence of your (next) paragraph (“I don’t smoke …), your age and especially, the slow growth of the lesion, the odds are much in your favor that this lesion is benign. Such slow growth of malignant tumors can occur, but is rare.
“this is a metastasized tumor from somewhere else.”
Again, the growth issue. If the lesion is a metastatic lesion now, it was a metastatic lesion 5 years years ago and no metastatic lesion grows that slowly.
“Can a lesion that may be caused by pneumonia get bigger over time with recurring chest colds, bronchitis?”
It may enlarge but not secondary to chest colds or bronchitis
“If I had a lesion from pneumonia in 02, and I had a flare up of bronchitis/pneumonia in June, could it have scarred the same place again?”
That would be extremely unlikely, unless you have some abnormality of your bronchial tree that interferes with normal mucous drainage and could predispose to recurrence of pneumonia in the same place. When pneumonia recurs in the same place, the worry is that the bronchus could be blocked by a tumor. In those instances, the recurrence usually occurs within a 3-12 month (max) period. But no tumor, big enough to obstruct a bronchus would have otherwise remained silent for this long period of time
The following is from the textbook
A nodule that has not changed in size for at least 2 years is probably benign. Considerable amounts of data have been accumulated on the growth rates of benign and malignant masses. The measure of growth is the volume doubling time (not the doubling of the diameter). Benign lesions almost invariably have a doubling time of less than 1 month or more than 18 months, with the volume doubling time for most peripheral pulmonary carcinomas being between 1 and 18 months (median 3 months)
In up to 20% of instances, a "lung nodule" visible on chest radiographs actually represents an artifact, chest wall lesion, or pleural abnormality; in some cases, CT is essential to determine the true nature of the opacity.[36] CT can be useful to define the morphology of the SPN and suggest whether it is benign, likely malignant, or indeterminate, having neither benign nor malignant characteristics. In some patients, a specific diagnosis of lesions such as rounded atelectasis ( Fig. 20.35 ),[55] a mucous plug, or arteriovenous malformation can be made based on CT findings, indicating the benign nature of the lesion. Other CT appearances suggest the presence of malignancy.[56][57] These include a spiculated or irregular contour[56][57]; the presence of air bronchograms within the nodule, bubbly air collections ("pseudocavitation"), or cavities; and a diameter of more than 2 cm (see Fig. 20.34 ).[56] The presence of several patterns of calcification can indicate that the SPN is benign; "benign" patterns include diffuse, central, laminated, and "popcorn" calcification ( Fig. 20.36 ).[36][37] In about 30% of benign nodules, calcium invisible on plain radiographs can be seen on thin-section CT. Carcinomas may occasionally show calcification, often in an eccentric or stippled pattern. The presence of fat within an SPN, indicated by a low CT attenuation coefficient), strongly suggests the presence of hamartoma (a benign tumor)[36][39][58] or lipoid pneumonia; such nodules can be safely followed with serial radiographs.
Malignant tumors tend to show greater enhancement than benign nodules after the rapid injection of iodinated contrast material.[38][59][60][61] Because the degree of enhancement depends on the amount and rapidity of contrast infusion, it is important to use a consistent technique. Injection of 420 mg of iodine per kilogram (approximately 75 to 125 mL) at a rate of 2 mL/sec is commonly used, with thin-section CT scans through the nodule obtained before the infusion, 1 minute after the beginning of infusion, and at 1-minute intervals for an additional 3 minutes. Enhancement of 15 H or more occurs with malignancy, hamartoma, and some inflammatory lesions. Enhancement of less than 15 H almost always indicates a benign lesion, usually a granuloma. Therefore, whereas positive results (enhancement of 15 H or more at any time point during the study) are nonspecific, negative results are quite useful. This technique has been shown to have a sensitivity of 98% and a specificity of 58% in diagnosing carcinoma. More importantly, the negative predictive value of this technique is approximately 96%.[61] CT nodule enhancement studies are most appropriately used for patients who have indeterminate nodules (i.e., those without typical benign or malignant appearances). The use of positron emission tomographic imaging (see Chapter 21 ) has also been shown to be very useful for distinguishing benign from malignant nodules.[62]
Good luck
