Resolved question:
About 2 years ago my husband started having shortness of breath with excursion, he is currently 45 years old, active and in decent shape so this didn't seem normal. He would need to stop the activity and really work to catch his breath and would sometimes get a headache as well. I sent him to Cardiologist and blood and stress test were all good. He skipped on the Echo and I couldn't get him back to the doc.
He was recently traveling on a business trip and was up all night with chest pain that hurt worse when he tried to take a deep breath. He went to ER to get checked out.- They saw something on the XRAY and did a catscan for a better look and it turned out it was not a clot but there are some spots and a partial collapse?
After looking up all the medical terms in the reports It sounds like everything is in his right lung.. the top and mid section have small nodules 3.3-3.5mm and he has a small lung collapse I'm guessing in the bottom of the lower lobe? The Xray says lower lobe the CT calls it dependent (medical term) but both sound like minimal? what does this really mean?
They also found fatty liver, and heart upper part of normal for size.
My concern is that something has been going on for awhile with this lung and I don't have a good feeling… could this be early cancer? He does not smoke but he chews tobacco since he was 15. He has diverticulitis we manage with probiotics and otherwise is in excellent health.It just seems the combination and length of time with short breath that its more likely this is something and not nothing? He has not had a previous Chest X-ray but we did find a previous CT from 2010 that says lower lobes are clear- didn't say anything about the rest of the lungs… it was an abdominal CT but it sounds like he didn't have the collapse part in 2010. What should we do to make sure he is ok and not have to wait it out since the nodules are so small?
Do we need to worry about the lung collapse part - can he fly home safely? He is feeling better now, he is using air filter in the hotel and it has helped but he sounds kinda hoarse. It took about 2 days with the filter for him to recover but he can take a deep breath now without any pain at all.
What follow up should we do on the fatty liver. He drinks socially but is not an alcoholic- we have really good insurance - should we see a specialist or just GP?
Also, he has no history of cancer and only cancer in his family was his uncle passed away with pancreas cancer. We don't know history on his fathers side, he had accidental death when my husband was 5.
Submitted:
4 Days
Category:
Pulmonologist
Dear patient,
Regards from doctor spring.
I had a look through the reports although I would have preferred the films.
Your husbands present condition, the CT report and what you suspected 2 years back are all different events although they led to discover one another. If you had asked me an opinion 2 years back ( or now, with the report done 2 years back), I would have asked you to relax, ask him to exercise a bit and to take deep breathing exercises. In fact i would have done every thing to comfort you.
Now the recent chest pain has to be pneumonia ( air space disease) but a normal CT thorax rules it out. In fact it rules out any known complication. I will ask you not to bother about the atelectasis (collapse of lung) also. So the plausible cause of the chest pain is musculo- skeletal pain, which has come down on rest. yes, hence he can safely travel.
However I am bothered about the 2 nodules, though small and may be ignored right now. So I will advise you to meet a pulmonologist, and have a 6 months follow up, repeat the CT scan after 6 months and then after a year. If the nodules remain stationary then also, we can ignore it.
Right now I can neither confirm nor refute a malignant cause for the nodules and hence I advise a followup
Hope i have answered your queries.
Regards
Dr. Jacob George P
MD, FCCP
Thank you, we will make sure he gets follow up CT. Is there a percentage of risk for malignancy? Also, should we see GP for fatty liver or what kind of specialist? Thank you
dear patient,
Regards again from our team.
There is a low risk for malignancy- however it is too early to comment. If it increases its size by 6 months, then we should do further investigations to confirm / refute the same.
I would not be bother about a fatty liver. I would advise a fasting lipid profile to see his cholesterol level, stress on exercise, and to abstain from alcohol. Right now no further consultation is required for the fatty liver.
Regards,
Dr. JACOB GEORGE P
MD, FCCP