Right Upper Lung Cavities: Symptoms and Concerns

Right upper lung cavity?

I have been experiencing shoulder pain, along with pain in my left lower back, and occasional calf cramps.
I recently had a chest X-ray that revealed a cavity in my right upper lung.
I was treated for a lung infection over a decade ago.
During this recent check-up, the X-ray showed a cavity in my right upper lung.
Additionally, after typing on my phone for an extended period, my arms also feel numb.
What could be the cause of these symptoms?

Zhang, 30~39 year old female. Ask Date: 2020/08/29

Dr. Zhang Ziyan reply Pulmonology

Dear Zhang,
"Shoulder pain, along with pain in the left lower back, and occasional calf cramps" can be challenging to address; it may be related to some form of myositis.
"A chest X-ray revealed a cavitary lesion in the right upper lung, and I had treatment for a lung infection over a decade ago.
This time, the check-up showed a cavitary lesion in the right upper lung." If you have previously undergone comprehensive treatment (such as for tuberculosis or other pneumonia), it is likely that this represents a chronic lesion.
A comparison with previous imaging from the original treatment site would be advisable.
"My arms also feel numb after typing on my phone for a long time." I experience this as well; the best remedy is to put down the phone, although it can be quite difficult.
Best regards,
Pulmonary Medicine Department, Changhua Hospital

Reply Date: 2020/08/29

More Info

Understanding the symptoms and concerns related to the right upper lung cavities, especially in the context of your recent findings, is crucial for your health. The presence of a cavity in the lung, particularly in the right upper lobe, can be indicative of several underlying conditions. Given your history of lung infection, it is essential to consider both infectious and non-infectious causes.

Possible Causes of Lung Cavities
1. Infectious Causes:
- Tuberculosis (TB): A common cause of lung cavities, especially in individuals with a history of lung infections. TB can lead to cavitary lesions due to the destruction of lung tissue.

- Lung Abscess: This can occur due to bacterial infections, often following pneumonia. The abscess can form a cavity as the body attempts to wall off the infection.

- Fungal Infections: Certain fungal infections, such as those caused by *Aspergillus* or *Histoplasma*, can also lead to cavitary lesions in the lungs.

2. Non-Infectious Causes:
- Malignancy: Lung cancer can present as a cavitary lesion, particularly in cases of squamous cell carcinoma. It is essential to rule this out, especially if there are risk factors such as smoking or a family history of lung cancer.

- Interstitial Lung Disease: Conditions like sarcoidosis or idiopathic pulmonary fibrosis can lead to cavitary changes in the lung tissue.

Symptoms and Related Concerns
Your symptoms of shoulder pain, left-sided lower back pain, and calf cramps may not be directly related to the lung cavity but could indicate a broader issue, such as referred pain from the thoracic spine or musculoskeletal problems. The numbness in your arms while typing could suggest nerve compression, possibly due to poor posture or repetitive strain, rather than a direct lung issue.

Next Steps
1. Further Imaging: A CT scan of the chest can provide more detailed information about the lung cavity, helping to determine its size, shape, and any associated findings that could indicate the underlying cause.

2. Pulmonary Consultation: Given the complexity of your symptoms and the findings, consulting a pulmonologist is advisable. They can perform further evaluations, including sputum tests, bronchoscopy, or even a biopsy if necessary.

3. Management of Symptoms: Addressing your shoulder and back pain may involve physical therapy, ergonomic adjustments, or pain management strategies. Ensuring proper posture while using your phone or computer can help alleviate arm numbness.

4. Monitoring: Regular follow-ups with your healthcare provider are essential to monitor the lung cavity and any changes in your symptoms.

Conclusion
The discovery of a cavity in the right upper lung lobe warrants thorough investigation to determine its cause. While your current symptoms may seem unrelated, they could be part of a larger clinical picture. It is crucial to work closely with your healthcare team to ensure a comprehensive approach to your health concerns. Early diagnosis and intervention can significantly improve outcomes, especially in cases involving potential infections or malignancies.

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