OpenHealth Q&A

Understanding Lung Nodules: Insights from CT and PET Scans

Hello! I appreciate your patience as I share the details of a situation that's become a bit lengthy. I'm seeking clarity regarding the results outlined below. Regrettably, my doctor has not been responsive and has not provided feedback on the findings from the three scans conducted over the past two months. Fortunately, new insurance will be effective starting April 1, allowing for better healthcare options! I am a 44-year-old male who visited a walk-in clinic due to several concerning symptoms: a swollen gland in my neck lasting for over a month, a sensation akin to having a marble lodged in my throat (which was initially linked to frequent heartburn), night sweats, weight gain, and some fatigue. However, my physically demanding job and young children probably contribute to that fatigue! After ordering a CT scan with contrast, the interpretations indicated an incidental nodule, leading to a second CT scan. This scan revealed a more concerning nodule and a liver cyst, prompting a PET scan. The findings from that test are also recorded below. Currently, I find that the night sweats have diminished significantly, although they occasionally return—especially with the rise in temperature and humidity. The original swollen gland remains so I can still feel it, but it feels reduced in size and was not mentioned in the results of the second and third scans. Overall, I'm feeling relatively well, though fatigue persists, likely due to the anxiety surrounding my condition. There is a notable family medical history that raises concern: my grandfather passed away from lung cancer in his late 30s, one uncle died of lung cancer in his late 40s, another uncle succumbed to liver cancer in his mid-60s, and an aunt is currently facing stage 3 colon cancer. Additionally, I was a smoker but quit 12 years ago. Just six months prior, I spent time in an area known for valley fever, which some sources suggest could lead to the development of misleading nodules. However, I'm uncertain whether this would still be relevant. Routine blood tests showed acceptable results, apart from minor deficiencies in vitamin B and D. Any insights into the level of concern we should have would be extremely helpful! Waiting three to six months for follow-up feels daunting to me, especially given the family history and those specific nodes exhibiting increased uptake. I tend to be anxious about these matters! Moreover, is it normal to see varying sizes of nodules, or is it reasonable to suspect that they may have decreased in size? ### CT Scan #1 (with contrast) **Key Findings:** 1. Benign lymph nodes in the cervical region, with a subcentimeter lymph node corresponding to the left-side skin marker. 2. Chronic sinusitis diagnosed. 3. A 10 mm nodule identified at the apex of the right lung; further CT of the lungs is suggested. ### CT Scan #2 (without contrast) **Findings:** Lower neck: Refer to a recent neck CT detailed separately. Mediastinum: No masses or lymphadenopathy present. Heart/Aortic arch: No aneurysmal dilation or coronary calcifications. Upper abdomen: A 1 cm cyst on the lateral segment of the left lobe of the liver; otherwise appears unremarkable. Thoracic esophagus: Normal findings. Chest wall/visible bones: Normal findings. Airways/lung parenchyma: A 10 mm non-calcified solid nodule at the pleura base within the lateral apical segment of the right upper lobe, and a non-calcified solid 15 mm nodule with slightly irregular edges in the medial basal segment of the right lower lobe. Mild mild centrilobular and paraseptal emphysema observed in upper lung zones. No bronchiectasis, endobronchial lesions, pleural effusion, or ground-glass opacities present. **Impression:** The 15 mm nodule in the medial basal right lower lobe is suspicious for malignancy; the 10 mm nodule in the right upper lobe shows less concerning features. Emphysema is noted. A PET scan is indicated. ### PET Scan **Findings:** **Brain and Neck:** Symmetrical FDG uptake observed in the brain; normal uptake in soft tissues of the neck and glandular structures without abnormal focal increases in metabolism. **Chest:** Evidence of emphysematous changes in both lungs. A 1.2 x 1.1 cm nodule is present in the medial basal segment of the right lower lobe with low FDG uptake (max SUV 1.3). Another similar pleural-based nodule measures approximately 0.9 x 0.7 cm in the right upper lobe, also exhibiting low FDG uptake (max SUV 1.3). Subcentimeter subcarinal and left upper paratracheal lymph nodes show increased FDG uptake (max SUV 5.2). Normal radiotracer distribution is seen in the myocardium, mediastinum, and soft tissues. **Abdomen and Pelvis:** Normal distribution of the radiotracer in the GI and genitourinary systems with no focal areas of abnormal metabolism or adenopathy evident. **Skeletal:** There is no indication of concerning lytic or sclerotic lesions or abnormal focal FDG uptake in visible bones. **Impression:** Nodules in the right upper lobe and right lower lobe show low-grade FDG uptake as described. Follow-up via low-dose CT chest is recommended in 3 to 6 months, in accordance with Fleischner society guidelines. The subcentimeter subcarinal and left paratracheal lymph nodes with increased FDG uptake appear nonspecific and possibly reactive.

Answers (1)

3/29/2025, 2:01:20 PM

OpenHealth AI

It sounds like you’re dealing with a lot of uncertainty regarding your health, especially with the findings from your scans and your family history. I understand your anxiety and am here to help you navigate this situation.

Key Points:

1. Two lung nodules were identified, both showing low FDG uptake, which is reassuring.
2. Increased FDG uptake was noted in some lymph nodes but may not indicate serious issues.
3. Follow-up scans are recommended for monitoring.

Explanation:

1. Lung Nodules: The nodules (10 mm and 15 mm) were previously concerning, but the PET scan shows low metabolic activity, which often indicates a lower likelihood of malignancy. However, these nodules should still be monitored as per the guidelines to ensure any changes are addressed promptly.

2. Lymph Nodes: The increased uptake in the subcentimeter lymph nodes is noted, but similar findings can occur due to infections or inflammatory processes, especially if they are reactive to any ongoing issues.

3. Family History & Symptoms: Given your family history and symptoms, it is normal to feel on edge. However, since you’re feeling relatively well overall and noticing improvements in certain symptoms like night sweats, this is encouraging.

Next Steps:

1. Monitoring: Prioritize the follow-up scan recommended in 3 to 6 months. This follow-up is crucial for tracking any changes in the nodules or lymph nodes. Keeping a record of any new symptoms or changes in your health during this period can be helpful.

2. Healthy Lifestyle: While awaiting your follow-up, focus on maintaining a healthy lifestyle:

   • Nutrition: Eat a balanced diet rich in fruits, vegetables, lean proteins, and whole grains.
   • Hydration: Stay well-hydrated, and consider maintaining adequate vitamin D and B levels through sunlight exposure and dietary adjustments.
   • Stress Management: Engage in activities that help alleviate stress, such as exercise, mindfulness, or hobbies you enjoy, which can also help with your fatigue.

3. Regular Check-ins: Make it a point to stay engaged with your healthcare providers. If you're not getting timely feedback from your current doctor, consider reaching out to other professionals once your new insurance starts or utilizing telemedicine options if available.

4. Awareness of Symptoms: Remain vigilant about any new symptoms such as increased fatigue, persistent cough, sudden weight changes, or any new lumps or swellings which should prompt a reevaluation sooner.

You are prioritizing your health by seeking clarity on these issues, and that’s important. If you experience any significant changes or worsening of symptoms before your follow-up, do not hesitate to seek care promptly. Keeping open communication with new healthcare providers may provide you with the support and answers you need.