Why might a 6mm and an 8mm spot be hanging out on a lung?
July 6, 2011 7:21 AM   Subscribe

Why might a 6mm and an 8mm spot be hanging out on a lung?

My 50-yr-old spouse has been feeling pretty crappy for a few months. Extreme fatigue, coughing, chest tightness and, she reported, "just not feeling right". Two months ago she learned that she had pneumonia (to which she's historically been prone), received an IV dose of antibiotics and was told to follow up w/doc in two weeks. After two weeks' time the pneumonia was not gone, so she was given a second course of antibiotics and instructions to follow up with her doctor in another two weeks. This most recent follow-up has revealed that the pneumonia is still hanging on, and she's been told it'll probably just take some more time to completely rid herself of that nasty.

What is more concerning is that her doc reviewed the scans done (CAT, for sure. PET also, maybe, I think?) and sees two spots on her lungs. One is 6mm, one is 8mm. Different lobes. She has been referred to a pulmonary specialist who she will see next week. In the meantime we're both just shy of terrified. Spots shouldn't be growing on lungs. I tried to research online but had to close the browser window after reading too many worst case scenarios. Not finding any previous Ask questions that address this situation. She's dealing with her fear by not talking about it. I am dealing with it by respecting her desire to not talk about it, but I also want to have some idea of what's going on in order to best support her.

You are not her doctor. Please, could you suggest some of the less dire explanations for why these spots are showing up? Also, are there any specific tests or questions or conversations we should have with her doctor or during her upcoming appointment with the pulmonary specialist?
posted by anonymous to Health & Fitness (11 answers total)
IANAD, but some quick googling suggests that small lung spots are commonly scarring, particularly after respiratory infections. Search 'granuloma'.

Your specialist is going to bring up a lot of possibilities and test/monitor for them, which is awesome and exactly what you want them to do. Even if it is something unwelcome, you can silently celebrate it has been detected while small.

Take good care of yourselves. All the best.
posted by Trivia Newton John at 7:37 AM on July 6, 2011

Could really be anything. I'm afraid there isn't much else to do but wait until you see them. Trolling the internet for explanations isn't likely to do much to alleviate your fears, as all you're going to get is a list of things that it could be but almost certainly isn't.

No one on here knows her medical history or has seen her films. Nothing we can possibly say will shed any light on what's going on here, and "spots on lungs" is far, far too general a description even for an expert to give any meaningful information.

You've got an appointment next week. This suggests that you have access to medical care. With that in mind, take comfort in the fact that if something needs to be done and can be done, it probably will be done. In the meantime, have a drink or something and just chill. Freaking out about it isn't going to help, and trying to come up with explanations for what it could be isn't going to help you not freak out.
posted by valkyryn at 7:40 AM on July 6, 2011

Rather than offer alternate amateur medical hypothesis to what drove you away from Google, let me just say, having lost my father to lung cancer, that lung cancer is generally not detected until it is too late to treat. In the week between first hearing of my father's first Xray indications of a problem, and his first consultation with a pulmonary specialist, we explicitly, as a family, agreed to be patient, and let the doctors diagnose his problem, and not borrow trouble from the future. We spent that week cleaning his yard, and pruning back some trees and shrubs, doing a lot of barbeque cooking, and listening to jazz. Dad was too tired much of the time to help much with the actual yard work, but he was glad for the work we were doing, and was outside to direct it every 15 minutes. The sunshine and activity, his favorite foods from the grill, and some good jazz, beer and whisky at the end of long, active days seemed to relax us all, and keep our minds calm.

In the next week or two, simply strive for calm and acceptance of whatever medical facts are going to be revealed in diagnosis. Deal with them when you have them, not before you have them. Get some sunshine, stay as active as her condition will allow, eat well, rest as needed, and try to enjoy the simple things about life. If you have a fight in front of you, better to enter it as rested and focused as you can be, than worn by worry.
posted by paulsc at 7:48 AM on July 6, 2011 [1 favorite]

Just an anecdote. My (healthy) 63 yo mother got a very bad case of pneumonia December 2009. It was February 2010 before she really fully recovered. However, in the aftermath, she also had a lingering spot on her lung. It took months for it to finally go away (late summer). The upswing was that a doctor looking at her CT scan noticed that there were nodules in her thyroid (which was also on the CT), and now she's being treated for Hashimoto's.
posted by kimdog at 7:52 AM on July 6, 2011

Could be anything, and by anything it could be something as bad as cancer to something as benign as, well, spots that appear for any number of reasons but go away after a while. CT scans aren't magic: they're pictures.

There is nothing you can do about it now but read and worry. What I can say is that CT reports with nodules typically have an attachment at the bottom of the report with a brief summary of the Fleischner criteria, which basically spell out what to do in terms of follow-up imaging. Keep in mind that the guidelines are exactly that, and that your spouse's MD or referred specialist needs to tie everything together clinically.

So Google up "Fleischner criteria," and you'll get some decent reading. Until then (and this is easy for me to say, of course), try not to worry too much because there's nothing you can do in the meantime, and your spouse's MD and/or pulmonologist will be giving you more guidance in the near future.

I'm in a rush right now and about to head out the door, but look for the official Fleischner report/paper.
posted by herrdoktor at 7:59 AM on July 6, 2011

I have a friend who is, even as I write this, recovering from having 'spots' on her lungs removed-it was mold. Yes-MOLD. Do yall live in the South where it is muggy/swampy? Doc told her it is not unheard of
posted by Frosted Cactus at 10:23 AM on July 6, 2011

Sarcoidosis is another reason for spots to light up on PET. It's treatable. IANAD, just someone who went through a similar instance with a family member. I know it's scary. Best wishes!
posted by Knowyournuts at 10:29 AM on July 6, 2011

Any contact with birds? Histoplasmosis is pretty common.
posted by headspace at 11:20 AM on July 6, 2011

My 94 year old grandmother had pneumonia in her 60's and has had a spot on her lung from it ever since. It never changes or grows...it's just always there. While We obviously can't diagnose over the web, know that a spot on a lung isn't always the worst case scenario, and that Google shows you the worst case scenario because people talk about them all the time. Benign spots that don't cause anyone symptoms (like my grandmothers) don't get talked about as much and therefore won't show up atop the Google search.

Not to mention that some pneumonias are viral and won't go away with antibiotics...have they done any sort of culture to see what's growing in there?

Do what you can to relax. Your spouse is under medical care and they are doing what they know to do to diagnose fully. This may not be the end of the world.
posted by MultiFaceted at 11:41 AM on July 6, 2011

I also had a family member get a scary mystery lung spot that turned out to be benign. It can happen. The best thing to do is something to get your mind off it until you have a better sense of what's up. Watch dumb comedies, watch escapist fantasy, read her a favorite ridiculous book, do some summer cleaning that you've been meaning to do, etc.

Make a good list of symptoms she has had, and questions for the doc.
-What exactly does the test tell us, vs what do we not know yet? How clear-cut are the results?
-What are my results vs what is the normal range? (write this down!) Is there evidence of a change in my results over time, and what are the past values vs current values? Is the change happening at a normal, fast, slow, rate?
-What are the range of diagnostic possibilities, and what's the likelihood of each at this point?
-What's the range of treatment possibilities, what are the pros and cons of each (effectiveness and how is effectiveness measured, what are the likely side effects, being at home vs in hospital, do we need a specialist treatment center)?
-What is the likely timeline of events for treatment and progress of the condition? If it's benign, will it change over time, and how often should she get re-tested? what kind of tests?
-Who would you recommend we see for a second opinion? (write this down!)
-If there is cancer, what is the type and stage? (write this down!) What tests are needed to determine these?
-What are the names of any drugs or treatments we are considering? (write this down!)
-After the tests (and later, after treatments) what are normal side-effects vs what is cause for concern/calling the doc for followup? (Sometimes eg nausea is normal, sometimes it calls for getting in touch with the doc; you want to know.)
posted by LobsterMitten at 12:26 PM on July 6, 2011

I can tell you this: even if it is cancer, my uncle had a quarter of a lung removed because of cancer, and went on to live another 10 pretty pleasant years, until he was somewhere around 80.

So, maybe even the worst case wouldn't be so bad.
posted by tel3path at 3:20 PM on July 6, 2011

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