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Tuesday, May 21, 2013
Right apical tiny nodule
Please explain what this "right apical tiny nodule" in the xray result of my husband..is this means he have a tb disease? Is this prevent him to work abroad? My husband presently work in qatar...last nov`07 he undergo medical exam here in the Philippines from the qatar`s affiliated hospital here,the result of his med exam here is "fit to work" so he enable to went to qatar..in his first xray here they`ve seen a small spot on his xray, so they require him again to have what they so called spot film again. So he did...as I`ve said in their final findings here the result is "FIT TO WORK" but when he arrived in qatar the govt their requires the employees to undergo a medical exam for them to have a residence visa there. He again undergone 2 xrays because they seen right apical tiny nodule. Again they did a series of lab test to him. The skin test result is negative. The sputum I think was negative again. But their final findings was "OLD TB" and "UNFIT to WORK"
That`s why his employer have to send him back home here in country cause the qatar govt didnt want to issue him a residence visa. Why is it here they FITTED him to work but there in qatar UNFIT to work? We are confused....
Please do explain what this case of my husband means?? He had no signs of having TB and never diagnosed having a TB disease before and never had taken any medications of TB.
I am not sure why the Qatar government declared your husband "unfit" to work. Perhaps you can get a written clarification of the reason for this classification. Each country has different medical requirements for obtaining residence or work visa. You will need to discuss this with your physician but if your husband's SPN is from "old tuberculosis (TB)" and there is no evidence of active TB disease, your doctor may be able to write a letter to the Qatar medical examiner's office stating the work-up that has been done and that there is no evidence of active TB disease or any other illness and that he should be "fit" to work.
Below we will try and explain what a pulmonary nodule is, what some of the causes are, and what work up can be done for it.
I am going to assume that your husband has only one nodule and not multiple nodules on his chest x-ray (CXR). One nodule is often referred to as a solitary pulmonary nodule (SPN). A SPN is usually round, less than 3 cm lesion (abnormal lung tissue) surrounded by normal lung tissue. The person usually does not have any symptoms, and the nodule is found incidentally when the CXR is done for another reason.
It is true that TB can cause a SPN, especially in areas of the world with an increase in the number of TB cases such as the Philippines. But there are other infectious and non-infectious causes of SPN. For example, fungal infections such histoplasmosis, blastomycosis, or cocciodiomycosis which are common in certain parts of the United States can also cause SPN. Some jobs such as bridge building or farming may increase one's exposure to fungi. Most people who have been exposed to and infected with TB or fungi do not develop SPN or have any symptoms. But if a person's immune system weakens due to another illness, then people who were previously infected with TB or fungi are at greater risk of progressing to active TB or fungal disease.
Most of the time, a SPN is benign (noncancerous) but there is a small chance that it can be malignant (cancerous). The risk factors for cancer increase if there is a history of smoking cigarettes, older than 45 years old, male, has respiratory symptoms, or has a history of cancer elsewhere in the body. A history of asbestos exposure may be linked to malignant SPN.
Some other non-infectious diseases such as rheumatoid arthritis, Wegener's granulomatosis, and sarcoidosis can also cause SPN.
Based on your husband's risk factors, it is important for your physician to determine what the likely cause might be. If you have an old CXR that showed the nodule in the past (more than 2 years ago) and it is stable, then it is less likely to be malignant and no additional work-up may be needed. Sometimes, a computerized tomography (CT) scan can better define the lesion. A biopsy may need to be done to rule out cancer.
Shu-Hua Wang, MD, MPH&TM
Clinical Assistant Professor of Infectious Diseases
Clinical Assistant Professor of The Division of Epidemiology
College of Medicine
The Ohio State University
Larry S Schlesinger, MD
Molecular Virology, Immunology and Medical Genetics
Environmental Health Sciences
College of Medicine
The Ohio State University