OpenHealth Q&A

Seeking Clarity on Lung Imaging Results: A Nurse's Dilemma

As a healthcare professional with over a decade of experience in pulmonary nursing, I'm reaching out for insights rather than consulting my colleagues directly, as I fear it may affect their candor with me. My mother has an appointment later this week, but anxiety over her condition is prompting me to seek answers ahead of time. For the past year, she has been experiencing intermittent shortness of breath, which worsens during activities like climbing hills, where she also develops wheezing. This wheezing only occurs with physical exertion. She has a smoking history that spans several decades but quit a decade ago, making the potential for COPD a possibility. Her oxygen saturation levels have generally been acceptable. I believed her primary care physician was monitoring her condition, but I recently discovered he hasn't used a stethoscope on her during the past four years, despite her ongoing symptoms. Instead, he would visually assess her and declare her fine. During one visit, after she requested he listen to her lungs, he briefly found a stethoscope and pronounced her health satisfactory. He prescribed an inhaler but failed to order any imaging studies. Recently, following a surgical repair of a hiatal hernia, her heart rate was noted to be elevated at 120 beats per minute, with oxygen saturation plummeting to 80%. This was surprising given that her prior pre-operative assessment just a week earlier indicated everything was normal. While we suspected the onset of a viral infection, the surgical team confirmed her operation would proceed regardless of a minor cold. Following surgery, her condition did not improve, leading to a hospital stay of five days, from which she was discharged with home oxygen. Two weeks post-discharge, her heart rate remained elevated to around 160 with exertion, and her oxygen levels dropped to 82% on room air, coupled with pain in her left calf. Due to her HMO plan, I requested a CT angiogram, but the follow-up was scheduled for eight days later. Frustrated with perceived negligence from her physician, I opted to take her to urgent care, where they identified a deep vein thrombosis but thankfully ruled out a pulmonary embolism. However, a 2.5 cm nodular consolidation was observed in her right lower lobe, along with two nodules measuring 6 mm in the left lower lobe. Subsequently, a week later, she underwent a non-contrast PET/CT scan, which surprisingly revealed none of the previously noted nodules, but did identify a concerning irregular 0.9 cm nodule in the central right upper lobe with a low maximum SUV of 2.2, which was absent in the contrast CT findings. The radiologist recommended a biopsy, suggesting that an infectious etiology is less likely. I have two primary questions: 1. Why did the 0.9 cm nodule not appear on the contrast CT scan? Given its size, I find it puzzling that it was only detected in the PET scan. 2. What happened to the three nodules initially identified on the contrast CT that were absent on the non-contrast PET/CT? While I understand that the 6 mm nodules are indeed small, shouldn't the 2.5 cm nodule have been detectable on the non-contrast CT? In my routine inpatient work, discrepancies like these are rarely encountered, and I am used to treating clearly defined diagnoses. I appreciate any thoughts or shared experiences on this matter; your input would mean a lot! Thank you! 🙏

Answers (1)

3/30/2025, 12:01:00 AM

OpenHealth AI

Thank you for sharing your concerns—it’s clear that you’re deeply invested in your mother’s health and seeking clarity on her imaging results amid a complex clinical picture. Here’s a summary that addresses your key questions, along with explanations and actionable steps.

Summary of Key Points:

1. Imaging Discrepancies: The nodule's inconsistent visibility in different imaging modalities can occur due to various factors related to their characteristics and the specifics of each imaging technique.
2. Nodule Characteristics: The changes in the detection of nodules on the CT scans are not uncommon, especially with different types of imaging (contrast vs. non-contrast) and the inherent nature of the nodules themselves.

Explanation:

1. Nodule Visibility:

   • Contrast CT vs. Non-Contrast PET/CT: Sometimes, small nodules or irregular shapes may be obscured by surrounding tissue or may not enhance adequately on a contrast CT scan. PET scans, which detect metabolic activity, can often identify malignancies or active infections not visible on standard imaging due to their increased cellular activity. This might explain why the irregular nodule was detected on the PET scan but not on the previous contrast CT.

2. Nodule Absence on PET/CT:

   • The change in visibility of the initially noted nodules could be due to several reasons including the resolution limits of the imaging, size dynamics, or even resolution differences between scans interpreted by radiologists. Small nodules (like the 6 mm ones) can also sometimes be missed or mischaracterized in such sequential scans. The interpretation may depend heavily on the imaging angles and the technology's sensitivity.

Actionable Steps:

1. Follow-Up Testing: Ensure that a biopsy of the 0.9 cm nodule in the right upper lobe is scheduled as recommended. This is crucial to determine the nature of the nodule and rule out malignancy.

2. Detailed Discussion with Radiology: If possible, facilitate a follow-up meeting with the radiologist that interpreted the PET scan to discuss any anomalies or questions you might have about scanning techniques and what the findings meant concerning her history and symptoms.

3. Monitor Symptoms Closely: Continue to observe your mother for any changes in her breathing, oxygen levels, or any new symptoms like increased pain, swelling, or changes in her calf.

4. Push for Comprehensive Evaluation: Given your observations about inadequate physical examinations, consider advocating for a more thorough assessment of her lung function. Routine pulmonary function tests and consultations with a pulmonologist may be warranted.

5. Continued Monitoring of Vital Signs: Keep track of her heart rate and oxygen saturation levels regularly. If there are significant changes, integrate that information when communicating with healthcare providers.

Empathy & Support:

Your dedication to your mother’s health is commendable, and it's natural to feel frustrated when navigating the complexities of medical care. Continue to advocate for her needs, and don't hesitate to seek second opinions if something doesn’t feel right. You are doing an excellent job considering her complex situation, and seeking clarity is an essential part of ensuring she gets the care she deserves. If you have more questions or need further assistance, feel free to ask.