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Wednesday, January 28, 2015
Solitairy pulmonary nodule
I am a 62 yr. old female. I smoked for nearly 40 yrs. and quit 5 yrs. ago when I suffered a heart attack. I have severe emphysema (COPD) and have been on oxygen 24/7 nearly 5 yrs. I was hospitalized in July, 2008 with pneumonia and CHF at which time a CT scan was done. The CT showed a right apical pulmonary nodule, radiology suggested followup with CCT scan in 3 months. I saw my Dr. after release and she stated that the nodule was nothing to worry about but we would do the followup scan. The doctor`s comment didn`t alleviate my fears since I know that with my age, smoking, and COPD, I am at high risk for a malignancy. I have a radiology report from a CT scan done 7/2006 that showed severe emphysema and partial lung collapse, but no nodule at that time. I`m concerned whether a wait and watch approach is best or perhaps referral to a specialist would be recommended. My overall health is clearly compromised and it`s hard to imagine dealing with another major health issue but I prefer to be informed as to whether I have any options regarding a difinitive diagnosis and/or a course of action to take at this time. I sincerely appreciate any information, education, etc. that you might be able to share with me.
Thank you for your question. The waitful watching approach to following a solitary nodule can be very stressful for patients. However, this approach may be very appropriate if based on several factors including the chronicity of the nodule (was it present on imaging in the past?), the appearance of the nodule including size, the patient's risk factors (smoking history, age, history of malignancy, and presence of obstructive lung disease) and if following published guidelines. You are correct in stating that your smoking history and lung disease do increase risk. Your level of comfort with the plan is extremely important as your caregivers follow this nodule. It is reasonable to discuss with your primary physician and if necessary seek further consultation.
Patrick Nana-Sinkam, MD
Associate Professor of Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University