Lung Issues: What to Do About Suspicious Findings

Pulmonary issues?

Hello Dr.
Jian,
A year ago, during a health check-up, I underwent a chest X-ray and a low-dose computed tomography (CT) scan.
The report indicated suspected pulmonary tuberculosis (I have not experienced any cough or symptoms).
I have been followed up in the outpatient clinic for a year, during which I had two X-rays and two low-dose CT scans.
In the report of the last CT scan, the doctor informed me that there are three white spots in my lungs that were previously separate but have now connected into a small area (located behind the bones, making it difficult to examine).
I would like to ask you, Dr.
Jian:
1.
Is the connection of the three white spots into a small area a bad sign? Could it be lung cancer?
2.
Is it necessary to perform a bronchoscopy and biopsy?
3.
I would like to seek a second opinion.
Will the electronic images of the chest X-ray and CT scan that I have prepared be usable and clear at the second hospital?
Thank you for taking the time to answer my questions.
Sincerely,
Julie

Julie, 50~59 year old female. Ask Date: 2016/08/30

Dr. Jian Shuntian reply Pulmonology

(1) The three small nodules later connected are likely not tumors; they could be pulmonary tuberculosis.
A biopsy and bronchoscopy can be performed.
If these two procedures are not done, or if they are done without conclusive results, a trial treatment for tuberculosis can be considered.
(2) A bronchoscopy or biopsy can be performed, and it is advisable to discuss the success rates and risks with the physician.
(3) The imaging studies can be clearly reviewed at other hospitals.
Thank you.

Reply Date: 2016/08/30

More Info

Dear Julie,
Thank you for reaching out with your concerns regarding your lung health. I understand that you have been closely monitoring some suspicious findings in your lungs over the past year, and I appreciate your proactive approach to your health. Let’s address your questions one by one.

1. Are the three white spots connecting into a small area a bad sign? Could it be lung cancer?
The appearance of three previously separate white spots now connecting into a single area can be concerning, but it does not definitively indicate lung cancer. Ground-glass opacities or nodules can have various causes, including infections, inflammatory processes, or benign conditions, in addition to malignancies. The fact that you have been monitored over the past year and have not exhibited symptoms such as coughing, weight loss, or night sweats is a positive sign. However, the change in appearance warrants further investigation to rule out any serious conditions, including lung cancer.

2. Is a bronchoscopy and biopsy necessary?
A bronchoscopy can be a valuable tool in evaluating lung nodules or masses, especially if there is a concern for malignancy. During this procedure, a thin tube with a camera is inserted into the airways, allowing the physician to visualize the lungs and potentially obtain tissue samples for biopsy. Given the changes in your imaging findings, a bronchoscopy may be recommended to obtain a definitive diagnosis. Your healthcare provider will consider your overall clinical picture, including your history and any additional imaging studies, to determine the best course of action.

3. Can I use the electronic images from my previous X-rays and CT scans at a second hospital?
Yes, you can typically take your electronic images (DICOM files) to another hospital or imaging center. Most facilities are equipped to read these files, provided they are in a compatible format. It’s a good idea to bring any relevant reports along with the images, as this will help the new physician understand your medical history and the context of your imaging findings. Make sure to check with the second hospital about their specific requirements for transferring and viewing your images.

In addition to these points, I would recommend that you continue to follow up with your healthcare provider regarding your lung health. Regular monitoring and imaging can help track any changes over time. If you experience any new symptoms, such as persistent cough, shortness of breath, or chest pain, it’s important to report these to your doctor promptly.

Lastly, while waiting for further evaluations, try to manage any anxiety you may have about your health. Engaging in stress-reducing activities, such as mindfulness or gentle exercise, can be beneficial. Remember, early detection and intervention are key in managing lung health issues effectively.

Please feel free to reach out if you have any more questions or concerns. Your health is important, and it’s great that you are taking the necessary steps to ensure it remains a priority.

Best regards,
Doctor Q&A Teams

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