Should I be Worried

[rocky1254]

I am unsure of what the below diagnosis means but should I be particularly worried about the 4.5mm nodule?

i was diagnosed with a 1cm cyst incidentally noted within segment 2 of the liver , solitary dystrophic calcification/ calcified granuloma is noted within the visualized spleen . also noted there is roughly 4.5mm nodule seen within the superior lingular segment on image 113/224 of the axial series...noncalcified and without obvious enhancement..also have degenerative changes present throughout dorsal spine, leading to significant multilevel thoracic spinal canal stenosis

[heartaches101]

Accidently a nodule and inflammed lymth nodes were discovered when i had a ct scan for another procedure.  They tried bronchoscopy, endobronchoscopy but enough samples couldn't be attained.  Then another brochoscopy and after the second dr. could not get the samples he continued to perform a mediastinoscpy and did attain samples of the lymth nodes but did not take samples of the nodule.  Why not ?  He told me they would be the same.  New pulmonary dr says they could be completely unrelated.  Only diagnosis is the nodes were caseating glamulomous....and now I have went for futher testing to see what the gamulomous are....TB has been ruled out by the blood test..as I do test posative to the the skin test and did have to take medication for almost a six months or a year.   I only completed half of the medication before i had a reaction and did not try a second drug.   Which now I think ....was problably not smart on my part.  My question is why would the doctor not  sample the nodules to be sure it was not cancer.   Would they appear so much differently.   I am going to have another ct scan in October...but really don't like the watch and wait and see if it grows..  It doesn't seem smart to me to wait until my nodule becomes a mass.  Plus I was a smoker for 30 plus years.   Yes I had already quit before finding out about this.   He did start a culture and it should be finished so...so I am hoping it can tell us something.  Plumonary dr did do a uriine test for histoplasmosis as we suspect that could have be the infection that caused the granuloma.  I hate to have another biopsy as I went through four scopes to get the last one.  I would hate to have another mediastinscopy but cant'  see any way around it since the first three scopes failed.  It just upsets me to think I thought the cancer scare was over until the pulmonary doctor said they could be totally unrelated.  He said he would do a pet scan if anything about the nodule or the lymth nodes had changed.  (last ct was june and next one is oct.)

[David Tinkelman, M.D.]

You should not be worried about the nodule, especially if you are young and a non-smoker.  Lesions this size are predominantly benign, although not always.  That you have a calcified granuloma within the spleen raises the possibility that both the lung and the splenic granuloma might reflect a (some time in the past) infection with either TB or a fungous such as Histoplasma, an infection that occurs with increased frequency in the mid-west.  

The first step should be to obtain all previous chest X-rays to determine if the 4.5 mm nodule was present in the past.  If it was and has not appreciably increased in size in the interim then it would not pose significant risk and a reasonable choice would be to follow it with one or two serial X-rays, in the future.  You should also definitely discuss the implications of this nodule and your options at this time, with the pulmonary specialist.

You should also be concerned about the spinal stenosis as this is a condition that could lead to chronic pain and/or muscle weakness.

Good luck