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Multiple Lung Nodules


I am a 43 year old male who started smoking at about 13 and was a continuous smoker until about age 40.  I had a duodenal switch with bypass surgery about 4 years ago and have had kidney stones since.  During a diagnostic image for stones, a nodule was noticed on my Right lung.  6 months later 5 more were found all under 1CM all calcified and the pulmonary clinic I saw indicated to me that they were not concerned at this point.  I have read that SPN is 40-50% likely to be cancer and now I have MPN and some pain in my affected lung.  TB testing is negative.   While I would not welcome a negative diagnoses, I want to know what the chances are that this is NOT good.  I know in 6 more months, there will be more information available, why do I have pain in my lung, could it be psycho-semantic?
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242588 tn?1224275300
With rare exceptions, calcified pulmonary nodules are benign, the nodules presumably a residual of prior infection.

That you have had kidney stones since the surgery suggests that the surgery may have been accompanied by an alteration in your calcium metabolism, with an increased propensity to calcification.  Increased oxalate levels in the intestine have been observed after bypass surgery and, as noted below, have been accompanied by calcium-oxalate kidney stones.  It is conceivable that the lung nodules were previously present but not calcified and, with the changes in metabolism have become calcified.  You may wish to pursue this with the Rochester Mayo Clinic doctors whose report is below.
Full Name Nelson, Wayne K. Houghton, Scott G. Milliner, Dawn S. Lieske, John C.
Sarr, Michael G.
Institution Mayo Medical School, Mayo Clinic College of Medicine, Rochester,
Minnesota 55905, USA.
Title Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy:
potentially serious and unappreciated complications of Roux-en-Y
gastric bypass.
Source Surgery for Obesity & Related Diseases. 1(5):481-5, 2005 Sep-Oct.
BACKGROUND: Neither the presence nor prevalence of enteric hyperoxaluria has been recognized after Roux-en-Y gastric bypass (RYGBP). We have noted a high rate of oxalate nephrolithiasis and even 2 patients with oxalate nephropathy in this patient population postoperatively. Our aim was to determine the frequency of the occurrence and effects of enteric hyperoxaluria after RYGBP.
METHODS: Retrospective review of all patients at our institution diagnosed with calcium oxalate nephrolithiasis or oxalate nephropathy after standard (n = 14) or distal (n = 9) RYGBP. The mean postoperative follow-up was 55 months.
RESULTS: A total of 23 patients (14 men and 9 women; mean age 45 years; mean preoperative body mass index 55 kg/m(2)) developed enteric hyperoxaluria after RYGBP, defined by the presence of oxalate nephropathy (n = 2) or calcium oxalate nephrolithiasis (n = 21) and increased 24-hour excretion of urinary oxalate and/or calcium oxalate supersaturation. Enteric hyperoxaluria was recognized after a mean weight loss of 46 kg at 29 months (range 2-85) after RYGBP. Two patients developed renal failure and required chronic hemodialysis. Of the 21 patients with nephrolithiasis, 14 had no history of nephrolithiasis preoperatively, and 19 of 21 required lithotripsy or other intervention. Of the 23 patients, 20 tested had increased oxalate excretion, and 14 of 15 tested had high urine calcium oxalate supersaturation.
CONCLUSION: Enteric hyperoxaluria, nephrolithiasis, and oxalate nephropathy must be considered with the other risks of RYGBP. Efforts should be made to identify factors that predispose patients to developing hyperoxaluria.

By any conventional standard these are small nodules less than 1 cm.  This, along with their multiplicity and now calcification, argues strongly in favor of their being benign.  The pulmonary clinic doctor not "being concerned" is warranted.  A repeat, localized CT scan in 6 to 12 months would almost certainly be re-assuring.

Calcified nodules do not cause "lung pain".  You and the pulmonary specialists should look for another cause of this discomfort.
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