Pulmonary nodule on Chest Xray

[peshi]

Relative who has completed 9 months uninterrupted TB treatment (Rifinah 300*2 and Pyrodoxine 23mg od now - had previous reaction to Pyranzinamide and therefore had to take ethambutol for first 3 months )has 2.8*2.4 centrally necrotic nodule within right lobe anteriorly. Nodule abuts pleural surface laterally bot there is only minor associated pleural thickening. Central and peripheral bornchiectasis within the right upper lobe with volume loss and nodular atelectasis posteriorly. There is sweeping peripheral necrotic wedge shaped area of consolidation within the right lobe anteriorly with surrounding amall airways disease.

CT guided FNA done today with results expected in 5 days. The objective is to elimiate other diagnoses which the doctors think is unlikely and to check for Live MTB1.  Doctor's view is that it is a tuberculoma.

However, I am really concerned that it might be cancerous. Please can you let me know your thoughts and the probability of it being a more serious issue.

thanks

[National Jewish Health]

What you describe is a complex diagnostic problem.  It is not possible to speculate on the likelihood of the lesion being cancerous without further information about your relative's age, smoking history, the basis for the diagnosis of tuberculosis (TB) and the CT appearance of the lesion.  Combined PET-CT scanning can sometimes allow for differentiation.

The occurrence of TB and non-small cell cancer of the lung, together, is not unusual in populations with a high incidence of TB.  This possibility should be kept in mind.

The doctor's suspicion of a tuberculoma in this circumstance is warranted.  Their attempt to resolve the issue of tuberculoma vs. other lung disease with CT guided fine-needle aspiration (FNA) is appropriate.  If this procedure does not resolve the question, it may be necessary to do a more invasive procedure, with consideration of a right upper lobectomy.

Once again, your relative's doctors, especially if experienced in the treatment of TB are in the best position to make decisions regarding diagnostic procedures and therapy.  They may want to consult with the mycobacterial diseases experts at National Jewish Medical and Research Center.  For your relative’s doctors to learn more they can read our Mycobacterial Diseases Consult Service information by copying and pasting this address

http://www.nationaljewish.org/patient-info/progs/med/mycobacteria/consult.aspx

into the address window of their internet browser.