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What Does This CT Scan Report Indicate?
I am a breast cancer survivor. In May 2017 it will be 10 years since being diagnosed and treated. In 2014 I had a CT scan of my lungs. There was scar tissue noted but no suspicious nodules. Three months ago a repeat CT scan showed a 4mm nodule on right lung. Three weeks ago I got pneumonia and started spitting up blood. A lot of blood. It was noted on CT scan I had multilobar ground glass nodules. It was also found that I had a 1.4 CM soft tissue nodule/cyst on left lung. I have an appointment with a pulmonologist on the 22nd of December. Should I be concerned that any of this could be mestatic breast cancer to the lung.
Mon, 27 Feb 2017
I am sorry you are experiencing these conerning symptoms. Without knowing a full account of your history it is difficult to truly appreciate the context on your symptoms, but I will try to offer some insight. The symptoms you present are clearly concerning, irrespective of your past history of breast cancer, but do not necessary direct me to recurrent breast cancer, especially if you have been in remission for >5 years. Coughing up blood can be the result of many different conditions;
1) metastasis from a primary breast cancer
2) primary lung cancer (especially if you smoke)
3) Tuberculosis (any recent travel to 3rd world countries)
4) Other pulmonary infections, such as pneumonia, bronchitis.
5) Esophageal varices in the context of chronic alcoholism, hepatitis B or C, and liver failure.
6) Esophageal cancer from chronic gastric reflux disease
7) Strep throat infections, although based on the amount of blood this seems less likely.
8) Mesotheliomas. Any environment exposure through work?
As you can see the differential is broad and varied. The CT scan raises suspicion for malignancy with a new onset lung nodule and bloody cough. Do you have a recent unexplained weight loss or night sweats? Another possible explanation is recurrent lung infections, especially in patients who are chronic smokers. This condition is called bronchiectasis and can lead to a condition where large cystic lesions develop in old scarred lung tissue. A pulmonogist can help answer these questions by doing some simple tests:
1) Basic blood tests
2) Sputum sample
3) Bronchoscopy with biopsy
4) Percutaneous biopsy of lesions
Some of the approaches above are invasive. If there is a strong suspicion for malignancy, perhaps it is best to proceed. Alternatively, a watch and wait approach with repeat CT scan in 3 months can be employed for lower risk patients. It is up to you and your pulmonologist to decide which course of action to take.
I realize now it is already past December 22nd, would be interested in hearing any updates on your progress.
Take Care
Marco M. Zahedi M.D., M.P.H.
Family Medicine
1) metastasis from a primary breast cancer
2) primary lung cancer (especially if you smoke)
3) Tuberculosis (any recent travel to 3rd world countries)
4) Other pulmonary infections, such as pneumonia, bronchitis.
5) Esophageal varices in the context of chronic alcoholism, hepatitis B or C, and liver failure.
6) Esophageal cancer from chronic gastric reflux disease
7) Strep throat infections, although based on the amount of blood this seems less likely.
8) Mesotheliomas. Any environment exposure through work?
As you can see the differential is broad and varied. The CT scan raises suspicion for malignancy with a new onset lung nodule and bloody cough. Do you have a recent unexplained weight loss or night sweats? Another possible explanation is recurrent lung infections, especially in patients who are chronic smokers. This condition is called bronchiectasis and can lead to a condition where large cystic lesions develop in old scarred lung tissue. A pulmonogist can help answer these questions by doing some simple tests:
1) Basic blood tests
2) Sputum sample
3) Bronchoscopy with biopsy
4) Percutaneous biopsy of lesions
Some of the approaches above are invasive. If there is a strong suspicion for malignancy, perhaps it is best to proceed. Alternatively, a watch and wait approach with repeat CT scan in 3 months can be employed for lower risk patients. It is up to you and your pulmonologist to decide which course of action to take.
I realize now it is already past December 22nd, would be interested in hearing any updates on your progress.
Take Care
Marco M. Zahedi M.D., M.P.H.
Family Medicine
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