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What Causes Lung Nodules?
Question: Dear Doctor XXXXXXX Chail,
I hope this finds you well.
I am writing to you regarding my brother health issue, He was in communication with you for long time and he believes you are one of the best doctor to give the right answer all his concern. He has lung nodules and I would like to travel with hi, to USA , but before of that I would like to ask you about opinion before getting any step , so i would like to send the CT for you but I think it will be via ( drop box ), so shall I send you the link ?? please advise.
Thanks and regards
XXXX
I hope this finds you well.
I am writing to you regarding my brother health issue, He was in communication with you for long time and he believes you are one of the best doctor to give the right answer all his concern. He has lung nodules and I would like to travel with hi, to USA , but before of that I would like to ask you about opinion before getting any step , so i would like to send the CT for you but I think it will be via ( drop box ), so shall I send you the link ?? please advise.
Thanks and regards
XXXX
Brief Answer:
Please upload images on Dropbox and send me link
Detailed Answer:
Hi XXXX,
Thanks for your appreciation and writing in to us.
I am doing well and hope you and your brother are well.
Please upload the CT scan CD or DVD complete contents on Dropbox and send me the download link. That way I can have a detailed look at all images and we can discuss the scan
Regards,
Dr.Vivek
Please upload images on Dropbox and send me link
Detailed Answer:
Hi XXXX,
Thanks for your appreciation and writing in to us.
I am doing well and hope you and your brother are well.
Please upload the CT scan CD or DVD complete contents on Dropbox and send me the download link. That way I can have a detailed look at all images and we can discuss the scan
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX ,
Thanks a lot for your reply Doctor , I am really appropriated.
Doctor XXXXXXX please find the attached report and I already download all the CT scan on the drop box as JPB and DICOM format for the( lung nodule ) . I would like to ask you kindly to fell free to use the account of drop box, user name : YYYY@YYYY and password is 0000 I hope it will be better and easier for you doctor for your convenient and this box is only for this ct . Thanks in advance .
I know Doctor it would be tough task for you but just i need some clarification from your side , since i know the overqualified Doctors have their own point of view to determine the benign from malignancy nodule from the shape, size , growth and margin etc so please help us in our case and really really we are very thankful for all your help and support.
With my best regards
XXXX
Thanks a lot for your reply Doctor , I am really appropriated.
Doctor XXXXXXX please find the attached report and I already download all the CT scan on the drop box as JPB and DICOM format for the( lung nodule ) . I would like to ask you kindly to fell free to use the account of drop box, user name : YYYY@YYYY and password is 0000 I hope it will be better and easier for you doctor for your convenient and this box is only for this ct . Thanks in advance .
I know Doctor it would be tough task for you but just i need some clarification from your side , since i know the overqualified Doctors have their own point of view to determine the benign from malignancy nodule from the shape, size , growth and margin etc so please help us in our case and really really we are very thankful for all your help and support.
With my best regards
XXXX
Brief Answer:
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
The CT scan images have been seen in detail by me.
Please find my observations below
1. The nodule is small and not exactly a concern if it measures 3 mm. As per internationally followed Fleischner guidelines, the Recommendations for Follow-up and Management of Nodules Smaller than
8 mm Detected Incidentally at CT are as follows.
(i) A nodule less than 4 mm in a low risk patient (non smoker and no other risk) requires no imaging follow up
(ii) A nodule less than 4 mm in a high risk patient (smoker) to be followed up by doing another CT at 12 months and if no change then no further imaging required
2. From the images it is clear that the nodule is attached to the lung pleura and is really small. The margins are sharp and well defined. But it is important to share with you that in a nodule of size 3 mm you cannot really comment about margin and that is why the international guidelines have been formed.
3. When assessing likelihood of malignancy for a nodule, the following criteria are evaluate
(i) Age: The risk of malignancy in a lung nodule is 15% between ages 40 and 49
(ii) History, underlying risk factors: Smoking, asbestos exposure, previously diagnosed malignancy and fever are risk factors
(iii) Size of lesion: 80% of benign nodules are less than 2 cm, but 15% of malignant nodules are less than 1 cm
(iv) Border characteristics: Benign lesions tend to be smooth and discrete. Malignant lesions have irregular, lobulated or spiculated borders. However 21% malignant nodules have well defined margins.
(v) Calcification of lesion: Eccentric or Amorphous calcification indicates malignancy usually
(vi) Cavitation of lesion: This may or may not be present with thick walls in malignancy and is not a sole criteria.
(vii) Presence of fat in lesion: Fat is an indicator of a possible benign tumor
(viii) Growth rate of lesion: Malignant lesions have roughly a doubling time between approximately a month and a year. This is difficult to measure in a small nodule. For example a nodule measuring 4 mm (volume 33.51 cu mm) can double in volume to become 5 mm (volume 65.45 cu mm) and another one measuring 3.0 cm (volume 14.14 cc) will double in volume to become 3.75 cm (volume 27.61 cc). Therefore the growth rate both are the same during a similar duration but to the eye the appearance might differ. This needs to be accurately measured and hence the guidelines suggest 12 month period for the high risk group after which another CT scan is to be repeated.
4. From the CT scan of your brother, it is best to consider his risk factors and repeat another CT scan in January 2016. This is to give the nodule enough time to double in size and its growth to be measurable. Rarely there are types of malignancy called broncheolalveolar carcinomas and carcinoid tumors can have doubling time greater than a year but we will not worry about that right now.
As such there are more than 90 percent chances that nothing will happen. However, considering your brother as my own patient, I suggest a close preventive wait and watch considering the worse case scenario.
5. The thyroid nodules might be discussed with his doctor and after ultrasound and with FNAC test report.
6. The kidney cyst looks regular and this can also be better seen and followed up at least once after 6 months on ultrasound scan abdomen.
7. The kidney stone is too small to be a concern.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Please find details below
Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.
The CT scan images have been seen in detail by me.
Please find my observations below
1. The nodule is small and not exactly a concern if it measures 3 mm. As per internationally followed Fleischner guidelines, the Recommendations for Follow-up and Management of Nodules Smaller than
8 mm Detected Incidentally at CT are as follows.
(i) A nodule less than 4 mm in a low risk patient (non smoker and no other risk) requires no imaging follow up
(ii) A nodule less than 4 mm in a high risk patient (smoker) to be followed up by doing another CT at 12 months and if no change then no further imaging required
2. From the images it is clear that the nodule is attached to the lung pleura and is really small. The margins are sharp and well defined. But it is important to share with you that in a nodule of size 3 mm you cannot really comment about margin and that is why the international guidelines have been formed.
3. When assessing likelihood of malignancy for a nodule, the following criteria are evaluate
(i) Age: The risk of malignancy in a lung nodule is 15% between ages 40 and 49
(ii) History, underlying risk factors: Smoking, asbestos exposure, previously diagnosed malignancy and fever are risk factors
(iii) Size of lesion: 80% of benign nodules are less than 2 cm, but 15% of malignant nodules are less than 1 cm
(iv) Border characteristics: Benign lesions tend to be smooth and discrete. Malignant lesions have irregular, lobulated or spiculated borders. However 21% malignant nodules have well defined margins.
(v) Calcification of lesion: Eccentric or Amorphous calcification indicates malignancy usually
(vi) Cavitation of lesion: This may or may not be present with thick walls in malignancy and is not a sole criteria.
(vii) Presence of fat in lesion: Fat is an indicator of a possible benign tumor
(viii) Growth rate of lesion: Malignant lesions have roughly a doubling time between approximately a month and a year. This is difficult to measure in a small nodule. For example a nodule measuring 4 mm (volume 33.51 cu mm) can double in volume to become 5 mm (volume 65.45 cu mm) and another one measuring 3.0 cm (volume 14.14 cc) will double in volume to become 3.75 cm (volume 27.61 cc). Therefore the growth rate both are the same during a similar duration but to the eye the appearance might differ. This needs to be accurately measured and hence the guidelines suggest 12 month period for the high risk group after which another CT scan is to be repeated.
4. From the CT scan of your brother, it is best to consider his risk factors and repeat another CT scan in January 2016. This is to give the nodule enough time to double in size and its growth to be measurable. Rarely there are types of malignancy called broncheolalveolar carcinomas and carcinoid tumors can have doubling time greater than a year but we will not worry about that right now.
As such there are more than 90 percent chances that nothing will happen. However, considering your brother as my own patient, I suggest a close preventive wait and watch considering the worse case scenario.
5. The thyroid nodules might be discussed with his doctor and after ultrasound and with FNAC test report.
6. The kidney cyst looks regular and this can also be better seen and followed up at least once after 6 months on ultrasound scan abdomen.
7. The kidney stone is too small to be a concern.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
First of all thanks a million for your informative report and all you effort , support and the professionality and interest to provide us with more detils and information which is really more than the Doctor given to us and thanks for consider my brother as your own patient it really our pleasure and I am really appropriated .
my last questions Doctor XXXXXXX
1:- shall we repeat the CT scan after 80 Days from the first one or no need ??
2:- We found X ray fro my brother from 18 month ago and other dates would that will be useful to give us any indications ??
3:her is the link for USA hospital shall we proceed with them or wait for 1 year http://www.valleyhealthcancercenter.com/Cancer-Services/Lung/Early-Diagnosis-at-The-Pulmonary-Nodule-Center.
4- shall I understand for your reply doctor that the chances the nodules will be benign is more than 90% .
Again thanks alot doctor and sorry for so many questions.
Best regards
XXXX
First of all thanks a million for your informative report and all you effort , support and the professionality and interest to provide us with more detils and information which is really more than the Doctor given to us and thanks for consider my brother as your own patient it really our pleasure and I am really appropriated .
my last questions Doctor XXXXXXX
1:- shall we repeat the CT scan after 80 Days from the first one or no need ??
2:- We found X ray fro my brother from 18 month ago and other dates would that will be useful to give us any indications ??
3:her is the link for USA hospital shall we proceed with them or wait for 1 year http://www.valleyhealthcancercenter.com/Cancer-Services/Lung/Early-Diagnosis-at-The-Pulmonary-Nodule-Center.
4- shall I understand for your reply doctor that the chances the nodules will be benign is more than 90% .
Again thanks alot doctor and sorry for so many questions.
Best regards
XXXX
Brief Answer:
A repeat chest X ray can be done and reviewed for suspicious activity
Detailed Answer:
Hi XXXX,
Thanks for your appreciation and writing back with an update.
Please find your questions answered below
1. Shall we repeat the CT scan after 80 Days from the first one or no need ??
CT scan involves a lot of radiation and this test must not be repeated frequently unless required. As per international guidelines, a CT scan chest is recommended for your brother at the end of 12 months considering that he might be in high risk group. Keeping this in mind, a repeat CT scan at 80 days is not needed.
As an alternative, he can get a repeat chest X ray done at 80 days and if there is any suspicious activity on chest X ray then under recommendation of his doctor, a CT scan chest can be arranged for. One CT scan chest radiation equals about 400 chest X rays so it is always better to go for a check chest X ray rather than getting a complete CT scan chest done frequently.
2. We found X ray fro my brother from 18 month ago and other dates would that will be useful to give us any indications ??
Old chest X rays are also useful, even if it is 20 years old. Please preserve the chest X ray taken 18 months ago and this might be useful for the future.
3. Here is the link for USA hospital shall we proceed with them or wait for 1 year http://www.valleyhealthcancercenter.com/Cancer-Services/Lung/Early-Diagnosis-at-The-Pulmonary-Nodule-Center
The above center is a nice place and they have got latest equipment. Since you and your brother are visiting the place and you surely want peace of mind, therefore you can always take an opinion. Your brother can register himself at the hospital and meet the doctor with the CT scan images and then if required, get a chest X ray which will also be reviewed. This can be followed up next year around the same time.
4. Shall I understand for your reply doctor that the chances the nodules will be benign is more than 90%
The nodule is most likely benign (more than 90 percent chances) but we cannot take anything with certainty. Being a little careful always helps and there is no need to worry but get it checked as per guidelines.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
A repeat chest X ray can be done and reviewed for suspicious activity
Detailed Answer:
Hi XXXX,
Thanks for your appreciation and writing back with an update.
Please find your questions answered below
1. Shall we repeat the CT scan after 80 Days from the first one or no need ??
CT scan involves a lot of radiation and this test must not be repeated frequently unless required. As per international guidelines, a CT scan chest is recommended for your brother at the end of 12 months considering that he might be in high risk group. Keeping this in mind, a repeat CT scan at 80 days is not needed.
As an alternative, he can get a repeat chest X ray done at 80 days and if there is any suspicious activity on chest X ray then under recommendation of his doctor, a CT scan chest can be arranged for. One CT scan chest radiation equals about 400 chest X rays so it is always better to go for a check chest X ray rather than getting a complete CT scan chest done frequently.
2. We found X ray fro my brother from 18 month ago and other dates would that will be useful to give us any indications ??
Old chest X rays are also useful, even if it is 20 years old. Please preserve the chest X ray taken 18 months ago and this might be useful for the future.
3. Here is the link for USA hospital shall we proceed with them or wait for 1 year http://www.valleyhealthcancercenter.com/Cancer-Services/Lung/Early-Diagnosis-at-The-Pulmonary-Nodule-Center
The above center is a nice place and they have got latest equipment. Since you and your brother are visiting the place and you surely want peace of mind, therefore you can always take an opinion. Your brother can register himself at the hospital and meet the doctor with the CT scan images and then if required, get a chest X ray which will also be reviewed. This can be followed up next year around the same time.
4. Shall I understand for your reply doctor that the chances the nodules will be benign is more than 90%
The nodule is most likely benign (more than 90 percent chances) but we cannot take anything with certainty. Being a little careful always helps and there is no need to worry but get it checked as per guidelines.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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