Three lung nodules

[Lorrie62]

I went to ER for atrial fibrillation and they took a CT chest to r/o PE.  Surprised to find 3 lung nodules:
"within the medial aspect of the R middle lobe, are 2 adjacent well defined nodules.  Larger nodule is 13 mm and smaller is 9mm.  A 6 mm nodule is seen peripherally in the lingula.  L lobe of thyroid gland, a 2.2 cm heterogeneous nodule. "  Pulmonologist thought it was mets from thyroid.  Had needle biopsy on thyroid last week:  negative.  Mostly round nodules with regular, smooth borders.   No sign of lymph nodes on CT or on body.   Mammogram 6 mos ago: negative  Breast exam by breast specialist 6 mos ago and 2 weeks ago: Good;  Sinus CT: Negative  Brain CT:  Negative;  Colonoscopy 1 1/2 years ago:  negative   62 year old non-smoker, excellent health except for paroxysmal afib and vestibular neuritis.  No hx of ca except basal cell carcinoma 2 years ago.  Mother had ductal ca in situ post menopause and father had colon ca at 50 years.  I get regular colonoscopies.  Please tell me these nodules can be benign.  thanks.  

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
Of course these nodules may be benign. Smooth borders and lack of lymph node enlargement point towards this. However, it is prudent to investigate thoroughly to rule out cancer.
A PET CT may help in this matter. Repeat (or image guided) FNAC of the thyroid is also indicated.
All the best, and God Bless!  

[Lorrie62]

I had the PET Scan and the 13 mm lung nodule had an SUV of 3.2.  The other two showed no uptake. However, there was mesenteric lymphadenopathy with SUV values of 8.1 to 8.6.  I had a dedicated CT scan of the abdomen on Friday and the largest nodal mass is 2.8 x 1.6 cm suggestive of Hodgkin's lymphoma.  Three of my doctors question this diagnosis for I have absolutely no symptoms of lymphoma.  I guess the next step will be a fine needle biopsy of the lymph node.  My questions are: 1) Can the lung nodule be benign at SUV of 3.2 and do you recommend a needle biopsy? 2) What can the lymphadenopathy be caused from if it does not prove to be lymphoma?  My CEA is normal.  Thank you again.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
A whole body PET CT is indicated.
Good Luck!

[Lorrie62]

Dear Dr.,

I forgot to mention that the nodules are non-calcified.  Would this make a difference in your opinion?  The radiologist just telephoned me and said the 3 good signs are 1) smooth borders 2) no lymph gland involvement and 3) no speculation.  The two negative signs are 1) size and 2) no calcification.  Thanks again.

[Lorrie62]

Thank you, Dr., for your prompt reply and encouragement.  Do you suggest a PET scan of the nodules only or a whole body PET scan?