lung granuloma CT scan

[gerhard]

Hi - I had some minor chest sensation (pain would be too strong of a word) in January; I couldn't tell if it was in the pectoral muscle or internal. So I went to a general MD, who recommended a CT scan from an 'unknown' on a chest xray. She said it could be an enlarged vein, or "something else." The radiologist looking at the CT scan said I had a granuloma nodule in my lung--common and not something to worry about. But the MD recommended another CTscan in 6months, just to be safe. In the meantime, I was denied health insurance. So the question is twofold:

1) is a granuloma something to be really concenred about? is the MD's recommendation sound practice, or just self-indemnification?

2) is there any way to convince a insurance company that it's OK without getting another CTscan (which, besides the expense, I understand exceeds healthy radiation exposure limits). Just another chest Xray?

Thanks for your help +

[National Jewish]

A nodule is usually a small, round shadow seen on chest x-ray anywhere in the lungs.  Nodules are due to infections, inflammation, or tumors.  A granuloma is a small cluster or nodule of inflammation that can occur in any area of the body, including the lungs.  If this inflammation leaves behind a scar this is also called a granuloma.  This inflammation could be due to an infection.  Both nodules and granulomas are common in certain parts of the United States.  Fungal infections are a common cause of nodules and granulomas in the mid-west due to Histoplasmosis and in the southwest due to Coccidioidomycosis also called valley fever.

Since tumors can be one cause of nodules and granulomas they are generally checked periodically over time to be sure that they are staying the same.  When there is change the goal is to notice the change early so that further testing can be done.  Then treatment can be started as soon as possible when it will be most helpful.  So your doctor’s recommendation of another CT scan in 6 months is sound practice.

If the granuloma nodule is clearly visible on the chest x-ray, a repeat chest x-ray in 6 months would be all that is needed.  However if the granuloma nodule is not clearly visible on the chest x-ray, a repeat chest CT scan would be needed.  There is certainly less radiation exposure with a chest x-ray than with a chest CT scan.  However, a chest CT scan is more sensitive and shows more detail than a chest x-ray.  It’s possible to notice slight changes in the granuloma nodule with a chest CT scan.  These slight changes may be missed with a chest x-ray.

As you can see this really comes down to a matter of the risk of radiation exposure compared with the benefit of finding changes in the granuloma nodule early.  For more specific information about the risk versus the benefit, please check with the radiologist responsible for radiation safety at the location where you would have this testing done.  This would be the best specialist to answer your question of exceeding healthy radiation exposure limits.

[4213Magic]

I am faced with the same type situation and like you are looking for some answers.  I recently had a chest xray which indicated "small dense nodules seen scattered throughout the chest most consistent with small granuloma".  I found the following information on the web and have posted a question to gather more specifics regarding my test results.  Hopefully the following will help get you one step closer to an understanding.  


GRANULOMA: A special type of INFLAMMATION characterized by accumulations of macrophages, some of which coalesce into "giant cells." Granulomatous inflammation is especially characteristic of tuberculosis, some deep fungal infections (like histoplasmosis and coccidioidomycosis), sarcoidosis (a disease of unknown cause), and reaction to foreign bodies.

Nodules are due to infections, inflammation, or tumors. It’s possible for the pneumonia to cause a nodule directly from the infection itself or indirectly by the infection causing inflammation. A granuloma is a nodule of inflammation that can occur in any area of the body.

[Sharkie]

I am replying to the comments on Granulomas as I had one removed from my lung almost 3 years ago.  a chest xray in the er room showed a lump on my right lung.  I was sent for the lung scan, then a lung biopsy, then they thougth it neccessary to remove the spot to see if it was cancerous through a horrible surgery.  It was not cancer, they never could tell me what the granuloma was caused by, and I have a permanent long and sometimes painful scar across my back.  We will never know what caused the granuloma even though they did extensive testing on it.  I was having it xrayed 2 times a year to see if it was coming back, but so far it has not and I have stopped the xrays by not going.  Be careful when a doctor suggests immediate surgery to check on these as was my case.  Do your homework first as the surgery itself can kill you.  I feel in my case it was not really neccessary to rule out cancer as the biopsy was showing no cancer cells.  Just do some investigating first.

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