Left Upper Lobe Nodule

[Linda682]

I am a 56 year old female with emphysema my pulmonary function test taken on 10/07 showed that my fev1/fvc was 39%.Since 2002 I had CT scans taken once a year due to several nodules on both lungs.Back in 11/06 my CT scan had showed that a spiculated lesion in the left upper lobe measuring 0.9x1.2cm.which it measured 5mm on the last scan in 11/05.It was suggested that I have a Pet/CT taken.On 1/15/07 I had the Pet/Ct taken which stated that there is a spiculated nodule in the left upper lobe measuring approximately 1 cm.there was no change in size or apperance compared to previous CT scan.This only demonstrates only mild metabolic activity with a maximum SUV of 1.0 g/mL well below the threshold value for malignancy.However this is of booderline size for metabolic characterization.And I should follow up with a CT every 6 months.I still was concerned I spoke with my surgeon who told me that due to my emphysema I am not a candidate for a needle biopsy because my lung could collapsed,and the best thing to do is follow up with the CT for the next 2 years.I did take his advised and also my pulmonologist.Every thing was fine but on my last CT taken 4/08 it showed that the nodule that was being watch grew from 0.9x1.2cm to 1.0x1.9cm in the left ipper lobe peripherally.It states findings raise the suspicion for malignancy and PET.CT scan may be performed for further evaluation.Somewhat less likely,this may be post-inflammatory in nature.When I went over the test results with my pulmonologist he said that according to the pictures of the CT scan and the shape of the nodule which is a triangle shape he feels that it is not malignancy and most likely scare tissue.He suggested that I don't have the PET/CT scan taken right away and wait at least 3 months because if I take the test to soon it my show the same results and he may get a false/positive read.To date I did not take the test but I am having the test taken on 6/28/08.Which is 9 weeks that I waited I can't wait any longer (mentally its getting bad) physically I feel good.But I would like to know if the shape of a nodule makes a diffrence if it is malignancy or not? I hopr that I did the right thing by waiting.

Thank You For Your Time
Linda

[PaulMD]

Hi.

Nodules with 'spiculated' edges are characteristics of a possible malignancy, however these should be proven with ancillary tests like the PET scan or a biopsy procedure.  I suggest that you make a second opinion with a thoracic surgeon that can confidently do the biopsy since even if the PET scan turns out positive, a biopsy is still warranted to ascertain the nature.  Other possible causes are sarcoid, tuberculosis, or indeed post inflammatory changes.  Regards.

[Linda682]

Thank you for answering my questions.I want to update you that I had my PET/CT scan taken this past Saturday 6/28/08,I have an appointment with my pulmonologist on Monday 7/7/08 for the results of the test.You had suggested that I go for a second opinion with a thoracic surgeon even if the PET sacn turns out positive.As I had wrote previously due to my emphysema my surgeon who is a thoracic surgeon told me that I was not a candidate for a needle biopsy for which my lung could collapsed.Are you suggesting if need to be that I go for a second opinion with another thoracic surgeon? Can you please tell me what is sarcoid?  

Thank You
Linda

[PaulMD]

It is possible that different surgeons can have different comfort levels when it comes to biopsy procedures.  Some are more confident in doing this even with your co morbid conditions.  An interventional radiologist can also be apt for the job of doing the biopsy.  Sarcoidosis is a granulomatous condition of the body where lumps called "granulomas" develop in different parts of the body, more commonly the lungs.  For more information you may visit this website:

http://www.nhlbi.nih.gov/health/dci/Diseases/sarc/sar_whatis.html

Regards.

[Linda682]

I am writting to you with an update with my PET/CT scan that was taken on 6/28/08 the Pet scan turned out postitive the nodule that was in concern was a hot spot and grew from  1.0x1.9cm to 3.6x2.2cm the report read that since it had increased in size from the previous exam and would be compatible with lung nenoplasm.My pulmonologist said that I need to have a biopsy taken.He said that even though the spot was hot it dose not always mean that its malignancy and that it could be other causes.He had referred me to a thoracic surgeon I have an appt on 7/23/08 for a consultation.I am just some what confused my pulmonologist seems so postitive that it can be caused by something else and the radologist seems negative with the results.Have you never heard of hot spots that were negative?

Thank you
Linda

[Linda682]

On July 18th I had wrote to you with an update regarding my PET/CT please read my last posting.I was scheduled for my biopsy on Aug 20th but it had to be cancelled because I developed mild pneumonia in the middle of my right lung  this past Wed.I was put on anti Levaquin 750mg.I may have the biopsy the end of Aug.I am very concerned beacuse if there is a chance of the mass being malignant and now with this set back how fast can the mass grow?  Since my PET/CT scan that was taken on 6/28/08.I know it's a hard question for you to answer, but in April is was 1.0x1.9cm and in June it was a 3.6x 2x2 cm.In a matter of 2 months do you feel that it grew quickly? And also in my last posting I had ask you if you ever heard of hot spots that were negative? Hope to hear from you soon.

Thank You
Linda

[Linda682]

I am writting to you hoping that you would be able to answer my questions.On July 18th and August 16th,I had wrote to PaulMD, as to date I have not heard back from him. Can  you please tell me if he is still affilated with MedHelp? If possible would you be able to read my postings for July 18th and August 16th,and wtite back to me.

Thank You For Your Help
Linda

[Linda682]

It has been awhile since I had wrote to you, On Sept 19th,2008 I had the biospy done I had a little hard time my lung had collapsed I had to stay in the hospital for 6 days.I do have good news the results were negative.I have to go back to my surgeon on Oct 22nd for a follow up with another CT with contrast and an x-ray,I will then also find out what the biopsy showed that I had?? As soon as I have more info.I will let toy know.

Linda

[Linda682]

I am concerned regarding when my lung collasped after my needle biopsy,I was told by a freind that I am now at risk for the lung to collasped again.Can you please tell me if this is true??? It is now 2 weeks that the Dr.sent me home but she did say that I have a very little space between the chest