0.4 cm Subpleural Nodule

Posted by rdunnigan @rdunnigan, Apr 9, 2019

I recently had a bout with diverticulitis which had to be confirmed on a abdomen/pelvic CT scan to make sure nothing ruptured. The diverticulitis was confirmed but then went on to say "There is a 0.4 cm/ 4 mm subpleural nodule in the left lower lobe best seen on axial image 14. The lungs are otherwise normal. Then in the summary, they said "Full CT scan of the chest without contrast is recommended." Well I FREAKED OUT!! The PA at my internist office was like "Oh we see these all the time, I'm not even worried about it, I'm more worried about the diverticulitis because that IS serious." I'm thinking to myself, are you nuts, this is freaking me out!! She kept saying please don't freak out, they're just suggesting to get a full CT chest scan since they only got half of the lung". So I contacted my friend's brother who's a radiologist and he said, "Robin, I see these all day, every day! They are nothing and you shouldn't get a full chest CT because the radiation with these scans is no joke and with that size nodule, under the Fleishner Society recommendations, that tiny nodule doesn't even qualify for a follow up because with nodules that small, you have a less than 1% chance of it being anything. Basically 1 and 6,000 chance of it being anything. The Fleishner society updated their recommendations saying anything less than 8mm doesn't require follow up because 99% of the time, they're benign. Therefore, why subject the patient to more radiation when the nodule is benign anyway." He also said, "What you're experiencing is all too common, there is rampant, unnecessary, excessive scanning today and the ER is the worst. These scans can actually cause cancer which is why the Fleishner Society is not only trying to reduce the amount of unnecessary scanning but also wanting to determine a safe distance between scans that doesn't increase the change of causing cancer. Also remember, there is a financial component to them wanting you to get a scan, make no mistake about it. If they see an opportunity to make money, they'll make a recommendation faster than you can say boo." He went on to say, "I would have never recommended a full chest CT and I'd make your doctor have that radiologist make an addendum." He said the radiologist will probably push back though, they hate being second guessed.

Anyway, I wake up every morning worried and based on what the second radiologist said, I'm being ridiculous. However, because I'm so fearful, I made an appointment with a pulmonologist to look at my scan. I can't help but think about what he said though. He's a doctor and he knows the money side of things we don't think about. It's hard to know which doctors just want money and who actually cares. I'd love someone's feedback, I hate waking up every day anxious like this.

@rdunnigan my reaction would be just like yours–worry. Were I you, I would indeed get a second, or third opinion. I would do this to put my mind at rest. Think seeing a pulmonologist is a good idea. Also, if you can see an oncologist. To my way of thinking, the latter has seen lots these things and cn reassure you more and guide you in what you ought to do. That's my opinion about this. Your peace of mind is important and would get at the least least the opinion of the (a) pulmonologist. Keep us posted.

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@rdunnigan– Good morning and welcome to Mayo Connect. I am so surprised at the attitude of your friend and the PA. I feel for you being put in this situation. First you were shocked and justifiably and secondly your feelings weren't validated and no empathy was shown. I'm sorry. This is a horrible thing that these two medical people have done to you.
Ok, let's start over here. I am a 22 year lung cancer survivor. I have had hundreds of CT scans and I'm concerned with the radiation but not with CT scans. I have not heard of anyone who has died from CT scan overload. Secondly, the radiologist and the PA are correct, lesions come and go, BUT that doesn't mean that they should be over looked. You should get a full chest CT scan to see what is going on. It might not be anything, it might have disappeared or it might be something that needs following.
I won't tell you not to worry or don't be scared. I can't tell you what will come of this but I can tell you that whatever it is, you will at least know what you are dealing with. Please come back and let me know what the CT shows. How is your diverticulitis? I have a friend who had this. It can be extremely painful and dangerous When is your appointment with the Pulmonologist? When you see him/her insist that you get a scan.

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