Monitoring Lung Nodules and Local Fibrosis: Key Insights and Follow-Up - Pulmonology

Follow-up on pulmonary nodules and localized fibrosis?

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Dear Director, I hope you are well.
I previously consulted you on this platform on September 7, 2021, regarding my health check in October 2020, which showed pulmonary nodules and localized fibrosis on a low-dose CT scan (the case number for my last inquiry was 173071).
At that time, you suggested that I return for a follow-up low-dose CT scan in six months to a year.
I followed your advice and returned to a major hospital for a follow-up in August 2022, where the physician arranged for a standard CT scan without contrast (not low-dose, and it was one and a half years since my last inquiry on this platform).
The findings from the CT scan are as follows:
CLINICAL INFORMATION: Abnormal CT was noted, with no cough, fever, or weight loss; no active symptoms/signs of respiratory tract issues; non-smoker.
Occupation history: not specific; Allergy history: none specific; Travel history: not specific (TOCC: not specific).
Family history: no family history of asthma, allergic rhinitis, or malignancy.
STUDY OF COMPARISON: CHEST CT SCAN ON 2020-10-29 (outside hospital images).
TECHNIQUE OF EXAMINATION: Pre- and post-contrast enhanced CT scan of the chest cavity was performed.
The scanning range was from the supraclavicular region to the diaphragm.
The reconstructed thickness was 5 mm.
Soft tissue windows were displayed for evaluation.
Findings:
1.
Lower neck and supraclavicular region: Unremarkable.
2.
Lung and pleura: Focal thickening of interlobular septa and pleura over the right lower lobe (RLL) (Srs: 605 Img: 137) with no change compared to the outside hospital image study, suggesting follow-up.
3.
Mediastinum: Poor evaluation of mediastinal or hilar lymph nodes, vascular, or other conditions due to the non-contrast study, suggesting follow-up.
4.
Adrenal gland, spleen, liver, and kidney: Unremarkable.
5.
Chest wall and spine: A large nodular lesion over the right lateral abdominal wall with fat-like density, ruling out lipoma, suggesting abdominal CT evaluation.
Degenerative joint disease (DJD) of the thoracolumbar spine.
IMPRESSION: As described above.
The report indicates that compared to the low-dose CT images from one and a half years ago, the localized pleural thickening over the RLL (localized fibrosis) has not changed.
Additionally, the originally concerning 3 mm nodule (identified during the health check in October 2020 and followed up with a low-dose CT scan in February 2021, where the physician noted it was still present but had become less distinct) was not mentioned in the report of the standard chest CT performed in August 2022.
After a follow-up consultation at the hospital, the physician confirmed that the 3 mm nodule was no longer visible in this CT scan, but the fibrosis in the right upper lobe remains unchanged as stated in the report.
I would like to ask you two questions:
1.
Regarding the localized pleural thickening over the RLL noted in the August 2022 CT scan, which shows no change compared to the low-dose CT from February 2021, you previously indicated that most of the fibrous changes are unlikely to change significantly.
Given that there has been no change after one and a half years (almost two years since the initial health check), does this suggest that the fibrosis in that area is unlikely to change?
2.
The 3 mm nodule in the left lung has disappeared in the August 2022 standard CT scan compared to the low-dose CT from February 2021, and this has been confirmed by the outpatient physician.
Is it possible that the disappearance of this 3 mm nodule could be due to other reasons?
3.
Based on the CT report from August 2022, what further actions should I take?

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Jerry Lin, 50~59 year old female. Ask Date: 2023/09/11