question of 9.0mm nodule in right lower lobe

[advice]

I have a question about a 9.0mm nodule found in the right lower lobe on a recent CT scan.  A spiral CT scan 1 year earlier showed the nodule to be 5.0mm. On previous spiral CT scan there is a history of a small calcified granuloma in the RLL measuring approx. 9.0mm. An additional tiny 5.0mm nodule is seen adjacent to this which is noncalcicfied. As well as within the mediastinum there are calicified lymph nodes seen in the subcarinal and precardinal region. No bulky lymphadenopathy is seen.  Findings: 1. compatible with healed granulomatous disease in the RLL and mediastium. 2. There is a tiny noncalcified nodule adjacent to a calcified granuloma in the RLL which statistically also likely represents a granuloma. History of patient, asthma, a respiratory infection within the last 8 months, hx. of colon ca receieved chemo.(The nodule thought not to be related to colon ca by oncologist because this is not normally a site that it would reappear first since scans show that problem cleared.) Recent findings on CT scan (not sure if a spiral CT)is this nodule now measuring 9.0mm in size PET scan shows it but it does not light up. Questions: 1. Could this be a granuloma that has grown over this year due to recent infection, because she has a hx. of healed granuloma disease and it is noted to be 9.0mm and it had to of grown at some time, or do they just appear at the size stated? 2.Is this not lighting up on the PET,  because it is to small? 3.Can benign growths grow? Recommended Tx. by Pulmonist is needle biopsy. Other options? Any information & your thoughts greatly appreciated.

[roey308]

A related discussion, nodules in lung was started.

[neassie]

hi- i was just diagnosed with multiple calcified granulomas and a couple undetermined nodules-i am 42-i have shortness of breath and chest pain- and severe fatigue -i have been told granulomas dont grow and i will re-ct scan in 3 months to see if there is growth-i am going to a pulmonologist soon-i am not happy with being told that its just scar tissue like it is no big deal when i am symptomatic and it is a big deal to me-anyone care to comment? thanks

[Ellis7]

I was told PET scans are 90-95% accurate in diagnosing lung cancer. However if the cancer is very slow growing, like BAC or a carcinoid, it might not light up.

I recall my doctor said a lung needle biopsy has a 60% chance of diagnosing cancer, if that is what it is. However this test could be nondiagnostic. It also has a 30% chance of causing a pneumothorax.

If the node is cancer I think the preferred treatment would usually be surgery [resection]. Radiation and chemo are reserved for cases where surgery is not an option.

Sometimes watchful waiting with periodic CT scans every few months is the way to go, if the diagnosis is in doubt and the proposed treatment is drastic. Also a 2nd opinion may be advisable in questionable cases, perferably from a high rated teaching hospital.

[advice]

Hi!
Thank you for your comments. In response To the answers I was told by the pulmonologist.
!. That granulomas do not grow.
2. That a nodule under 1cm which this is slightly under, at 9.0mm
   sometimes do not light up.  The information on PET scans that
   I have is from the pulmonologist and oncologist. I have not
   spoken with a radiologist as of yet.
3. I was told benign nodules do not grow like this by the
   pulmonologist and based on my medical background I could not
   understand this because I have always known just the opposite
   but respected her position thinking she definitely knew far
   more about the lung then I do since this is not my medical
   area.
4. As regards to the needle biopsy, pulmonologist and oncologist
   are already leaning towards this being malignant because they
   have already discussed options of radiation or chemo or a
   combination.  As well as their opinion of what they think her
   lungs would tolerate.
   Thank you again!



  

[CINDY4]

Sorry, when I read your post again I realized you do have asthma and an infection.  Has this infection been resolved for 8 months or are you still troubled by it?  

Have they done blood work?  If not I would request it.  I assume your oncologist does a regular work up in that respect.  

A granuloma or nodule, I believe these are basically the same thing, can be a result of infection.  

Cindy

[CINDY4]

The needle biopsy sounds like a good idea, you need to find out the cause of the granulomas, and any other damage that may be there and not show up on CT.  The PET scan not lighting up the area is expected.  A CT scan seems to be the best tool to date to give the most accurate and detailed picture of lung disease.  It is considered to give the best imaging in lung disease over both an MRI and PET scan.

I don't know about the significance of the size of the granuloma or nodule.  Benign tumors can grow sometimes to huge proportions.  You may want to look up other info on granulamatous lung disease on the web.  I know of Wegener's granulomatosis, and chronic granulamatosis disease, but there are many others that can produce granulomas.  What are your other symptoms?  Any sinus, infection, asthma, chest pain, cough, etc.?

Cindy

[National Jewish]

1. This could be a granuloma that has grown.
2. You should ask the pulmonologist and the radiologist who interpreted the PET scan your question about