CT Scan translation

[whittie918]

on 4/25/07 I had a complete physical.  The Chest Xray showed a 2.5 x 1.5 nodule. My doctor spent years as an ER doctor and said he seen TONS of these things and this one does not look cancerous.  He got a second opinion and it said the following:

There is a 2.5 x 1/5 ovoid soft tissue nodular density in the mid right lung laterally with proximal linear margination.  Chest is otherwise negative.  Impression: Pulmonary ovoid nodular density or nodular scar in the right mid lung laterally with medial linear fibrotic component.  THis could be on post inflamatory basis.  Neoplasm arising in scar or pulmonary vascular malformation, granuloma or haratoma in the differential.  Correlation with old chest radiographs if available would be of benefit.  

I can tell you now, my baseline chest xray did not have it.  Fast forward to 11/29/07.  I'm getting admission testing for thyroid cancer surgery and the surgeon wants a Chest CT just to be safe.  Chest CT says this:

Within the right middle lobe peripherally, there is approximately a 15-mm noncalcified nodular pleural-based density which has an associated perenchymal density which tails centrally.  This corresponds to the radiographic abnormality. The CT appearance is more suggestive of a benign etiology though this is not confirmed.  No other pulmonary nodules are identified.

Opinion: Right middle lobe parenchymal nodular density, pleural based.  While bengin etiology is favored, I would recommend followup in 3 months.

Surgeon looked at the actual scan and said it looked beign to him too.  He referred me to a pulmonologist just to be safe.  I have an appointment but waited for my post thyroid RAI scan to make sure it was not thyroid.  It is not.

Truth be told, I had a bad case of pneumonia on 2/07 and I really thing this may be the result of that.  I did not take care of myself at all at the time, continued to work and looked like walking death.

Tell me straight up, should I be prepared to hear its cancer?  

[whittie918]

My one year following chest xray showed less density and slightly smaller nodule.  They wanted me to get a CT scan to make sure.  In your opinion, do you think this is necessary?  I'm trying to avoid any extra CT's scans if I dont need them.  Plus, end of July I get another whole body scan from the thyroid cancer doctor.  They will most likely see this lung density in that and compare, right?  Do you think I need to still see a lung doctor too?

[whittie918]

Oh, sorry.  I did not get an iodine scan before RAI.  I guess it would have made sense but my Endo wanted to be quick about treatment I suppose. I understand that doing this pre-scan pushes off the actual treatment dose of RAI.

So waiting and re-scanning IS the standard treatment then huh?  I guess I feel better knowing that then.  

Thank you for all your help.  I feel I understand better now why so many tests.

[HeinrikMD]

Hi,
I was wondering if there was an iodine scan before the RAI, but it seems that there wasn’t. If the PET did not suggest a malignancy for the lung finding – then this is a good thing. A word of caution though: PET while promising, is not a validated tool for the specific purpose of screening for cancer.  At any rate, if there is no strong case to think it is cancer, the next step may well be monitor with another scan after an interval of a few months.

[whittie918]

I did undergo an RAI for thyroid cancer.  The CT scan notes originally posted was done the day after my thyroid remove.  I assume that without the iodine or contrast, it would have been hard for them to determine it thyroid or not.  Then I had another pet/ct scan 3 days post treatment and I dont have the notes from that but basically no light up.  

Thank you for your reply.  I appreciate it.

[HeinrikMD]

Hi,

There is no clear relationship between pneumonia and cancer. There is no compelling feature mentioned that would raise the possibility of malignancy. The tests of course would have their limitations, and hence a position of caution (which is the recommendation to have a follow-up scan after an interval of observation) is routine.

Did you undergo an RAI for thyroid cancer? You mentioned waiting for a post thyroid (treatment?) scan, and there was nothing in the lung based on that report. Did you undergo any pre-treatment scan? Because successful treatment with RAI may render a lung metastasis as absent on the RAI scan, but there may still be a residual scar. Metastasis from thyroid to lung isn’t very common though.