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Incidental lower lung module found
Hello everyone looking for some help/guidance. I had a lung screening 11/12 everything was normal repeat in 1 yr was the report. On 12/23 I had an abdominal CT for another issues from gastric. This stated incidental finding 3.8mm sublpleural nodule lower right lung. I went to PCP with my scans on a disc for him to review and tell me what to do. He didn’t look at the scans and said I need to go to pulmonary and sent the referral on forward. Pulmonologist office callled and will not schedule me bc the scan they have is if the chest CT and nothing is showing up on it, so she said we can’t schedule for what they are wanting you to be seen about bc it isn’t there. I explained the issue and that I have a scan and report stating nodule. She said that they are likely to want another chest CY before they will schedule me. But my question to everyone here is if the first chest CT didn’t catch which is what I thought they were supposed to do, why would a second? I know that the nodule is fairly small at the moment but everything I’ve read up on didn’t have much good to say about a lower lobe nodule on the right side. I am 45 yrs old for Lee smoker been quit 5 yrs. Which is why I kinda worked up at the moment. Is it possible for it to have not been there during the original chest CT and grew that much in 6 weeks or that it was just missed in the first one? And the second report didn’t even compare to the first and leave any detail of shape, solid or anything. Any help would be greatly appreciated bc I am really stressed at the moment and don’t know what to do. Thank you
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Each and every office/provider(doctor) want their OWN images/xrays/scans. It is bulls***, and not fair to us patients, but I hae learned that we must jump through their hoops for results. Have the scan. Prayers for a good outcome
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1 ReactionI finally got a appt with a pulmonologist. What can I expect and what questions do I need to ask?
ask him to submit the CT to a center specialized in lung-nodule-CT-interpretation
CDC has a big public database on these
https://www.cancerimagingarchive.net/collection/lidc-idri/
Is that something that I can do? Or does it have to be submitted by a doctor?
it depends. If you pay by yourself (typically $100-300)
you may find sources for radiologic,patient, 2nd opinions online.
But few reviews, it's hard to know in advance how good they are.
Some give a sample report.
I once found "national diagnostic imaging" , but only for USA
(I'm from Eutope)
and only for doctors,hospitals.
I don't know what US-insurances cover.
First, let's talk about the reading and interpretation of CT scans. When a CT scan is ordered, the doctor explains what they are looking for, you make an appointment and the tech performs the scan.
A radiologist reads the scan and reports the findings back to the doctor; concentrating on the reason for the order, other items found are reported as "incidental findings." Depending on the orders, the report may be text only, text with relevant slides, or text with the entire CT file.
Here is an interesting description of one radiologist's way of reading images:
https://www.neighborhoodradiologist.com/how-i-read-imaging-studies/
The ordering doctor reads the report/views the scan (and may consult further with the radiologist, a colleague or a specialist) then interprets it to you. You may then be told all is well, or you may be referred to a specialist.
Why see a pulmonologist? As a generalist, your doctor "knows a little about a lot of things", but as a specialist the pulmonologist "knows a lot about some specific things." They have at least 6000 hours of additional training, and day-to-day experience adds thousands more hours to their personal knowledge database.
My pulmonologist re-reads all CTs and interprets them based on her knowledge and experience. She often shows me specific images noted by the radiologist and explains why they are or are not significant in my case. I would not suggest that she submit my CT scan to a third party, she would know to do it herself if she had questions.
So, I would meet with the pulmonologist. Here are some questions I might ask -
-Why is there a difference between the CT findings?
-If you recommend additional imaging, how does it differ from what is already done?
-What specifically does the nodule suggest at this point (based on size, shape, location, appearance of total lung, your medical history) based on your education and experience?
-Is this of immediate concern, and if so, what is the next step?
-If not, do we follow up to see if the nodule changes? How often?
Does this help you in planning your visit? When is the appointment?
Yes this helps out greatly. I’m just kinda concerned at the moment is all. I know the nodule is still relatively small, but it concerns me that the 2 scans differ so much within a short time period. And if it’s due to the area being hard to screen than how are we going to effectively monitor it. I’m hoping all this will be answered during my visit.
I just had a Calcium Heat Scan and they found a smooth round nodule on my lower right lung. Those aren’t really clear images. I did see a Thoracic Surgeon. He said it looked like a Carcinoid nodule, which is a Neuroendocrine. She ordered a full Chest CT. It measured 1.4 cm x 1.1 cm. I also had an older one that was on a Chest CT measured 4mm. That one is not a concern. It’s been the same size since 2017.
Tuesday I am going for an FDG PET San to see what lights up. If any cancer, I’ve most likely caught it early, or I hope it’s a Carcinoid Typical nodule, which is slow growing. Those are usually smooth. No other characteristics were mentioned on CT.
My doctor said there's no way of telling what kind it is until we do an ION biopsy. That is a robotic guided biopsy.
She said it could be nothing, but the size is concerning and since this was found incidentally we don’t know how long I’ve had it. So my last lung CT was done 10/17 and it was not there. So in 7 years when did it begin and did it grow slowly or aggressively is the unknown.
If it’s an aggressive form of Carcinoid it’s Atypical.
I am going to suggest if surgery is going to happen whether I have a biopsy or not and she doesn’t feel I need a Dontatate Scan and she sees where all the cancer is then do the VAT’s surgery and remove everything and then do the biopsies. Why go through 2 if surgery is inevitable.
Now i
I had a number of nodules 7 mm and under that were caught on an X-Ray in 2013. I saw a Thoracic Surgeon. He monitored them via Chest CT w/o contrast again 3 months, 6 , 9 and 12 months via CT then once a year until end of 2017 with no growth and released me. I was a 1/2 pack a day smoker for 39 years up until 1/2012 is probably why he monitored.
But recently I had a Calcium Heart Scan during a well visit exam and they incidently found a new 1.4 cm x 1.1 cm new lower right lung nodule. It is smooth and my Thoracic surgeon said it appears to be a Carcinoid /Neuroendocrine but could be nothing. Going for a FDG PET scan Tuesday to see what lights up.
I went straight to a Thoracic Surgeon. First time I was monitored for 4 years. Multiple scan the first year in case it was a fast growing cancer. 3 months, 6, 9 and st 12 months. Then yearly after. 2017 I was released. But recently found a new larger one incidently on a Calcium CT Heart Scan. Heart scan was fine, but new problem with Lung. Did a Full Chest CT and she thinks my 1.4 cm x 1.1 cm may be Carcinoid/Neuroendocrine because it’s a smooth nodule with no other characteristics. Tuesday going for a FDG PET Scan to see if anything else lights up.