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Lung Cancer

Cloudy area in lung

07/15/2009

Question:

I have had a ct lung scan every 6 months to keep track of a 5mm lung nodule. I just had another one and was told they are no longer concerned with the lung nodule because it has not grown in 2 years. But I was told there is now another area of concern. There is a cloudy area in my lung. The doctor is putting me on a 5 day treatment of an antibiotic. I have to go back to see him in a week. I must have a follow up regular lung x-ray in two months. What does all this mean and is it safe to wait this long. My grandmother died of lung cancer and this has me concerned. Thank you for any information you might be able to give me.

Answer:

A cloudy area in the lung could represent an infection, especially, if it was not seen on the CT scan 6 months ago. Although, the possibility of malignancy is always present. If it is quite a big area that was not present 6 months ago, then most likely it is an infection. Also, the location of the cloudy area is important as there is some infection that are more likely to be in the upper part of the lung, than the lower part. It is a common practice to obtain a chest x-ray after 5-10 days of antibiotic, if the suspicion of an infection is high. If it is an infection, on the repeat chest x-ray, the cloudy area should be improving with antibiotic treatment. Sometimes, it may represent a scar that will not change at all even with antibiotic. In that case you may need to continue following up. Sometimes, chest x-rays lag clinical improvement. That is why your physician ordered a chest x-ray in 2 months. However, a cloudy area seen on chest CT may be better to compare with another CT, as it may appear different on the chest x-ray and may not allow appropriate comparison. I think, in your case it is reasonable to wait for 6-8 weeks to have another imaging study to see if this cloudy lesion has disappeared or changed in size shape or character. Thanks.

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Response by:

Shaheen  Islam, MD, MPH Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
Hematology
College of Medicine
The Ohio State University