subpleural nodule

My wife had a rib fractures in the 6,8,9,10 ribs  6 months back ( dec 2008). No specific treatment was given . Somewhere in mid-feb 09 , she developed asthma and coughing. She is now on Tuberculosis -ve treatment . She is responding okay to the treatment . Her tuberculosis is not confirmed , yet she has been adviced to take medicine for 3 months . As she was complaining of chest pain now and then , a CT scan was done . It showed callous formation at the rib fractures . Also a tiny subpleural nodule measuring around 6 * 6 mm was found abutting the fissure . What does this signify ? Is it somekind of infection due to the fractures or it is malignant ?

[National Jewish Health]

You have identified 3 problems:  1) rib fractures; 2) asthma; and 3) tuberculosis (TB), inactive, on prophylactic therapy.  The callous formation is evidence of rib fracture healing and effectively rules-out other causes of rib fracture.  I am unaware of any cause and effect relationship between rib fractures and the onset of asthma symptoms.  However, if rib fractures result in pain, sufficient to restrict breathing, retained secretions could result in wheezing, most likely transient.

A 6 mm nodule is, by conventional standards, a quite small nodule.  Nodules of this size are, in the great majority of cases, secondary to past, sometimes distant past infection and benign; frequently, a residual of past infection with TB, contained by her immune system.  Your wife would do well to follow the advice of her physicians, with regard to any need for follow-up imaging, CT scan or other, of the nodule.

Her TB is almost certainly what we call inactive and there will be no bacteriological evidence to confirm it.  In this instance having any sign of healed TB and a positive skin or blood test for TB is considered an indication for 3 months of prophylactic medicine.

You and your wife need not worry about this nodule.

Good luck.