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What Does Right Sided Hilar Mass In Lungs Indicate?

Posted on Fri, 13 Feb 2015

Question: I am a 67 y.o. male. My question has to do with lung cancer as I am a former 30 pack year smoker and I worked 40 years on the r.r. Exposed to dust , asbestos , silica etc. I have a c.t scan for lung cancer annually. As of now, I don't have lung cancer, but a 8 mm calcified nodule was found inthe right upper lung years ago, but it has been stable. I had my annual lung cancer screen a week ago. The results were emailed to me. The most prominent finding was" a densely calcified right sided hillar nodal mass that is probably related to previous granulomatous disease. The nodal mass measures 2.5x1.9x2.3cm in greatest dimensions." My last ct scan was 10mos. ago and it wasn't there then. Is it possible for something that is cancerous to grow that large in that short of a period? This ct was done with contrast. All the other ones were not. Would that be something to be more likely to show up on a contrast scan and not one without? If it was previous granulomatous disease, why wasn't there last year. That is the part that doesn't make sense to me. I haven' t heard from my doctor for a follow up or for a biopsy, but I do have an appointment with him in early March. I know large nodules in the lung are more likely to be cancerous, but based on my dr. Non reaction he doesn't seem to be concerned. What are your thoughts,. Cancer?

Answered by Dr. Drkaushal85 (3 hours later)

Brief Answer:
it may be infectious in nature.

Detailed Answer:
Hello dear, thanks for your question on HCM.
I can understand your situation and problem.
Since right sided hilar mass (present in recent scan) was not in old scan (10months ago),it is mostly due to disease process. Following are the possibilities.
1. Tuberculosis
2. Fungal infection (histoplasma)
3. Healing due to radiotherapy or chemotherapy (if taken in past for cancer)
4. Rarely cancer
So possibility of infection is more than cancer because calcification is not a feature of cancer. Calcification suggest healed lesion. Another point in favour of non cancerous lesion is growth time. Cancer will not grow this much in 10 months time.
Contrast is actually used to differentiate between dead and vascular structures. Dead areas due to poor blood supply,do not take up contrast. While vascular areas like cancer, pneumonia etc will take up contrast and seen different on CT images. Since your post contrast CT shows calcified nodule in right hilar,it is mostly due to old healed lesion and less likely due to malignancy.
Biopsy is the only way we can diagnose this correctly.
So get done biopsy.

I also want to know about this.
1. Have taken chemotherapy or radiotherapy?
Please reply me the answer,so that I can guide you better.

So your right hilar calcified nodules are less likely due to cancer but biopsy is needed for confirmation.

I will be happy to help you further.
Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Shanthi.E

Follow up: Dr. Drkaushal85 (7 hours later)

In 2010 I was diagnosed with papillary carcinoma of the thyroid. I had a Thyroidectomy. I have been monitored closely since then and everything has been going well. Could this be metatastis thyroid cancer? I never had chemotherapy, but I did have the radioactive iodine treatment one time after my Thyroidectomy in 2010.

Answered by Dr. Drkaushal85 (43 minutes later)

Brief Answer:
Yes, it can be metastatic thyroid cancer.

Detailed Answer:
Hello dear,

Thanks for your follow up question on HCM.

Your right hilar nodule can be due to metastasis from papillary thyroid cancer. As papillary thyroid cancer can cause secondaries which can give calcifications.

So this can be the cause.

But biopsy is needed to diagnose this.

Hope I have solved your question.
I will be happy to help you further.

Wish you good health.

Thanks.

Above answer was peer-reviewed by : Dr. Ashwin Bhandari

Follow up: Dr. Drkaushal85 (3 hours later)

I do not know what to do. I am due to have lower back surgery in March for a herniated disc as I have radiculopathy and can barely walk. This has been going on for 6 mos. if I have back surgery I will be incapacitated for months. I do not know how I will be able to fit them both in. If I wait to have back surgery I may end up a cripple as I have a herniated disc severely pushing on a nerve. I do not know why my dr. Isn't scheduling a biopsy ASAP.

Answered by Dr. Drkaushal85 (33 minutes later)

Brief Answer:
Will need to know few things.

Detailed Answer:
Hello dear, thanks for your follow up question.
I can understand your situation and problem.

I need to know few things before answering this question.
1. Have you undergone PFT in the recent past?
2. Are you doing physiotherapy for herniated lumber disc?
3. Are you having metastasis in spine?

Please reply me these answers, so that I can guide you better.
I will be happy to help you further.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health.
Thanks.

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj