29y old nonsmoker concerned.

[Denasal]

Im a 29 years old male. I dont smoke and never had. My wife and friends dont smoke too. Noone from my family died because of cancer.  I have a strange symptoms that worries me since almost 9 weeks. This is the story:
First two weeks: All started with terrible pain and tickling in my throat combined with hoarsness and fever. After a day i started to cough, it was productive severe cough. I was taking Amoxycylin and after a week everything was fine, fever and sickness went away. But cough persisted.

3 week: Cough went better. I had cough only in the morning around 5-10 times. But this time i was coughing up phlegm mixed with blood. Plus i had strange pain in my back near liver and in my shoulder. A real terrible pain. I was sent to lung doctor, he did ultrasound of everything below my rib cage and chest xray. Everything was fine he said.

4-8 week: Pain suddenly dissapeared. Cough was still there but without blood. It was drycough just morning and only few times a day. In those weeks i had constant throat tickle feeling combined with constant feeling to clear my throat during the day. Otherwise everything was fine.

9 week (now). Cough in the morning is still there but better. Throat irritation is better but still there. Now i feel small pain in my shoulder and near my liver. I went to ENT. Blood test was okay. He looked into my throat and found nothing. I feel awesome, just this damn cough and throat irtitaion dont go away.

During this 9 weeks i was taking Pentoprazol for acid reflux, didnt helped.
And Budesonid inhalator wich helped just a little.


Now i cough a lot more when i lie on the right side. And lying on the right side also cause tickling sensation on my right side of the throat. Lying on left side cause nothing. I have this feeling that the whole cough since beggining was only on the right side. little pain near my liver and shoulder came back. But its just a little and its not constant, it comes and go.

[Denasal]

Two days ago i had CT with contrast and they found 1,6cm nodule on lower side of my right lung. And something that looks like a Thymus that doesnt shrinked in my puberty in size around 3cm. My home doc and my pulmologist keeps telling me that this isnt a cancer. How can they be so sure ?. Im freaking out. I have pains since beggining originating from location of this 1,6 nodule. I can post my CT photos of it. And maybe translate the piece of paper with described result, cause its in German.
Translated as best as i can : "The shares are also covered caudal thyroid orthotopic and dense homogeneous. Larger greasy degenerate and thus insuspekte axillary lymph nodes. No lymphadenopathy in the upper thoracic aperture. Usually Rights opacification of normkalibrigen large mediastinoscopy-hilar vessels. No detectable pathologically enlarged lymph nodes in the mediastinum and in both Hili.
Conspicuous triangular loosened slightly inhomogeneous structure of parasagittal 2.1 cm length and 3.2 cm right left leg a craniocaudal extension of 3.8 cm in präaortalen mediastinal adipose tissue. No Perikardeguss and no pleural effusion.
1.6 cm wide pseudo solid nodular consolidation in subpleural location in the dorsal sinus phreniccocostalis right, most likely a scar change accordingly. The rest of Pulmo is a veritable parenchymal. No pulmonary lesion, no confluent pulmonary infiltrate and no interstitial pulmonary lesions. The central bronchial arises as far as normal.
Pleuropulmonales residual scar in the dorsal costodiaphragmatic recess right. Suspected Thymusrest in typical situation/place. No detectable local and locoregional aggressiveness drawing, as far as assessed by computed tomography.
Usually computed tomographic representation rights of the remaining thoracic organs."
I dont know what to do.

[David Tinkelman, M.D.]

What you describe is consistent with an infectious/inflammatory process of your upper respiratory system, bacterial or viral, either of which can often be associated with lingering cough, sometimes as long as 3-6 months.  Just as infection (Pertussis –Whooping Cough a prime example) can trigger the inflammation of asthma that then takes on a life of its own, so can it also lead to what is called hyperreactivity of the upper airways, including one’s throat and that may be responsive to anti-asthmatic drugs including inhaled steroids.

The key thing in this circumstance, particularly the presence of sputum mixed with blood is to rule out more serious diseases of the lungs, throat or sinuses. Your consultation with the ENT will have served that function with the upper airways.  And, your consultation with the “lung doctor” would rule out diseases of the lower airways (the lungs).

You mention acid reflux as a possible cause and I would agree.  Lack of improvement with the use of Protonix, a proton-pump inhibitor, does not rule out that diagnosis.  If your symptoms do not entirely resolve or recur and are even worse, further evaluation of your upper intestinal tract for acid reflux would be a reasonable approach.

Good luck