[Guest]

I just received a radiology report from a thoracic spiral CT scan that said the following:
DIAGNOSIS:
Tiny nodule in the right middle lobe. In a patient with a smoking history, short term follow up is recommended.
Linear changes suggesting mild scarring at both lung bases.
COMMENT:
A non-enhanced CT scan of the thorax was performed in a patient with a smoking history. There are no prior studies for comparison.
In the right middle lobe there is a 2-3mm nodule. This is indeterminate in appearance and may well represent a small granuloma. However, in a patient with this history careful follow-up is needed and repeat CT scan in three months in recommended.
A calcified granuloma is visible near the left hilum. No other granulomas are apparent. There is some mild scarring at both lung bases. No other lung masses are visible. There are no effusions. There is no mediastinal or hilar adenopathy.
Limited unenhanced views through the upper abdomen show no abnormality. The bones appear normal.

What are the chances that the nodule is cancer? Why would the radilogist say that the nodule is "most likely" a granuloma when he/she also said that the nodule was "indeterminate" in appearance? Why didn't the radiologist give the specific location and size of the nodule? If the advice is to watch it and follow it up in three months with another CT scan, how will I know if it got bigger if the radiologist didn't give the exaxt size in the first CT report? How does the radiologist know that the calcified granuloma is indeed a granuloma and not cancer? Why didn't the radilogist specify the size, appearance, etc of the calcified granuloma? From some of the material that I read, the pattern of calcification is important as it may be cancerous. Does having these two mean anything? What causes mild lung scarring at the base? What does "linear changes" mean? Why didn't the radiologist specify where the scarring was or give an opinion as to the cause of the scarring as he/she did with the nodule and the granuloma? I am 46, female, smoked from age 19 to 29 and then quit for 13 years and went back to smoking about five years ago.
Is there any other test that will give more info, eg. MRI PET? What does a PET show? What is the difference between an MRI and an MRA? Thank you.

[Guest]

Lots of questions. I’ll try to be brief. In chest CT there are findings to worry about and findings not to worry about. Granulomas which a small areas of old inflammation are very common and of no worry whatsoever. These beebee size nodules are most often calcified and appear very dense on x-rays and on CT scans. Linear changes are small areas of scarring or areas of unexpanded lung tissue are also very common and generally do not cause any serious problems.
The size and location of the nodule are given in the report… 2-3 mm in the right middle lobe. This nodule probably is another small granuloma. Unfortunately, it is too small to get an accurate reading of its density. So, just in the unlikely event that this tiny nodule is a tumor, it is safe practice to do a short term follow-up. They may even want another follow-up. If you need more information, you should be able to eyeball the radiologist who interpreted the study and ask him/her.
I think the nodule is too small for PET. MRI would not help.
MRI refers to the whole field of magnetic resonance imaging while MRA is a section of the field of MRI that deals with MR angiography or the imaging of blood vessels.

[quote] I just received a radiology report from a thoracic spiral CT scan that said the following:
DIAGNOSIS:
Tiny nodule in the right middle lobe. In a patient with a smoking history, short term follow up is recommended... [/quote]

[Guest]

I appreciate your quick response, however, I am still a little confused. Why would the radiologist say that the 2-3mm nodule is "most likely" a granuloma when he/she also said that the nodule was "indeterminate" in appearance? Also, if the nodule is 2-3mm in size, does that mean that the nodule is oval shaped (2mm x 3mm), or does it mean that the radiologist couldn't tell if the nodule was 2 or 3mm? Or does it mean that the nodule is somewhere between 2 and 3mm? How do I get a second radiology opinion? Is there a specialty like thoracic radiologist? Radiology is one of those few medical specialties where the patient does not get to pick the doctor. I know nothing of the skill, education, background, experience, etc of the radiologist that read my films. Thank you!
[quote]
Lots of questions. I’ll try to be brief... [/quote]

[Guest]

I understand your concern. There is a Society of Thoracic Radiology and that would be a good place to look for a second opinion. Personally, I would check with a chest radiologist at NYU or Cornell in NY where they do many screening lung CT's and really know what all those little dots in the lung mean.
[quote] I appreciate your quick response, however, I am still a little confused. Why would the radiologist say that the 2-3mm nodule is "most likely" a granuloma when he/she also said that the nodule was "indeterminate" in appearance... [/quote]

[Guest]

Thank you. I will check it out although I live quite a ways from NYC. However, again, why would the radiologist say that the nodule is "most likely" a granuloma when he/she also said that the nodule was indeterminate in appearance? Also, is the nodule oval shaped, ie. 2mm x 3mm, is it somewhere between 2mm and 3mm, or can't the radiologist tell what size it is? Thanks.
[quote] I understand your concern. There is a Society of Thoracic Radiology and that would be a good place to look for a second opinion... [/quote]

[Guest]

I was hoping to get an answer to the above question. It would really be appreciated. Thanks.
[quote] Thank you. I will check it out although I live quite a ways from NYC... [/quote]

[Guest]

The term "most likely" is generally used to express probability of diagnosis. If 90% of such small nodules turn out to be benign granulomas then one may say that chances are this one underconsideration is probably a granuloma. Indeterminate in appearance means that the nodule is just to too small to offer up any evidence as to its nature.
As for measurement, you must realize that CT is a digital imaging modality and as such spatial resolution is limited. Measurement errors of a few millimeters is not unusual.
[quote] Thank you. I will check it out although I live quite a ways from NYC... [/quote]