Unexplained Lung Abnormalities: Seeking Answers for a 70-Year-Old Patient

Q: Unexplained Lung Abnormalities: Seeking Answers for a 70-Year-Old Patient

Hello： Without imaging data, it is difficult to determine which condition is more likely. <br>Based on your description, diagnosis may not be easy; a 7 cm increase in size over 9 months raises concerns for a tumor that cannot be ruled out. <br>A bronchoscopy should be performed t

Lung abnormalities have been present for over two months, and the cause is still unknown?

Hello, doctor.
My mother is 70 years old and has recently shown abnormalities in her lungs.
The situation is as follows:
1.
A few years ago, she had pulmonary tuberculosis in her right upper lung, so she has been undergoing annual X-ray examinations for follow-up.
2.
In March 2015, her chest X-ray was normal.
3.
On December 15, 2015, an X-ray revealed a large abnormality in the right upper lobe.
4.
A CT scan on December 29, 2015, showed a 7 cm abnormality, which the doctor suspects may be lung cancer based on its shape.
5.
In early January 2016, a comprehensive examination was conducted, and no cancer cells were found in the liver, gallbladder, gastrointestinal tract, brain, blood, or bones.
6.
At the same time, a fine needle aspiration was performed on the abnormal lung cells, and no cancer cells were detected.
7.
A culture for tuberculosis was performed for 32 days with no results.
8.
After the discovery, she was treated with antibiotics twice for 5 days each time.
9.
On February 17, 2016, a chest X-ray showed no significant changes; the abnormality still persists.
10.
So far, she has not exhibited any symptoms.
Currently, the doctor recommends another fine needle aspiration or a self-paid PET scan.
We are considering switching to another hospital for the aspiration examination, but the doctor at that hospital requires her to take antibiotics first.

What suggestions do you have regarding her current situation? What should we do? What could this possibly be?
Regarding pulmonary tuberculosis: The culture has not shown results after 32 days, and the doctor believes the shape seen in the CT scan does not resemble tuberculosis, making it unlikely.

Regarding pneumonia: The antibiotics have had no effect, and there have been no changes over time, making it also unlikely.

Regarding lung cancer: Given the size of the abnormality over a few months, to my knowledge, other than small cell lung cancer, other types would not grow this large so quickly.
However, if it were small cell lung cancer, it should have increased fourfold in two months, but the X-ray shows no significant changes.
What could this issue possibly be? Thank you very much.

Zhuo Xiansheng, 30~39 year old female. Ask Date: 2016/02/18

Dr. Jian Shuntian reply Pulmonology

Hello: Without imaging data, it is difficult to determine which condition is more likely.
Based on your description, diagnosis may not be easy; a 7 cm increase in size over 9 months raises concerns for a tumor that cannot be ruled out.
A bronchoscopy should be performed to check for any intratracheal issues, and another biopsy may be necessary.
During the examination process, consider another course of intravenous antibiotic treatment.
Thank you for your attention.

Reply Date: 2016/02/18

More Info

In the case of your 70-year-old mother, the recent lung abnormalities raise several important considerations. Given her history of pulmonary tuberculosis and the current findings, a thorough evaluation is essential to determine the nature of the lung lesion and to rule out malignancy or other serious conditions.

Understanding the Findings
1. Previous History of Tuberculosis: Your mother’s history of tuberculosis (TB) is significant. TB can lead to residual lung changes, including scarring or fibrotic lesions, which may sometimes mimic malignancy on imaging studies. However, the fact that she has been monitored annually with X-rays and that a significant abnormality was only recently noted suggests that this lesion may be new.

2. Imaging Results: The CT scan revealing a 7 cm abnormality in the right upper lobe is concerning. The size and the rapid change in appearance from previous imaging warrant further investigation. While the lesion's characteristics may not definitively indicate cancer, the size and the fact that it has grown significantly in a short period are red flags.

3. Needle Biopsy and Imaging: The recommendation for a needle biopsy is a standard approach to obtain tissue for histological examination. This is crucial for determining whether the lesion is malignant or benign. The absence of cancer cells in previous biopsies is reassuring, but given the size of the lesion, a repeat biopsy may be necessary to ensure accurate diagnosis.

4. PET Scan Consideration: A PET scan can provide additional information about the metabolic activity of the lesion. Malignant tumors often show increased uptake of the radioactive tracer used in PET scans, which can help differentiate between benign and malignant processes. However, it is important to note that not all malignant lesions will show increased uptake, and some benign conditions can also show uptake.

5. Antibiotic Treatment: The recommendation to start antibiotics before further investigation may be aimed at ruling out an infectious process, such as pneumonia or an abscess, which could explain the lung abnormality. However, if the antibiotics do not lead to improvement or resolution of the abnormality, further diagnostic steps will be necessary.

Recommendations Moving Forward
- Consultation with a Pulmonologist: It would be beneficial to consult with a pulmonologist who specializes in lung diseases. They can provide a comprehensive evaluation and guide the next steps based on the latest imaging and clinical findings.

- Consider the Risks and Benefits of Procedures: Given your mother's age and overall health, it is important to weigh the risks and benefits of invasive procedures like a biopsy. Discussing these with her healthcare team will help in making an informed decision.

- Follow-Up Imaging: If immediate biopsy is not feasible, consider scheduling follow-up imaging (such as a repeat CT scan) in a few months to monitor any changes in the lesion.

- Symptom Monitoring: Keep track of any new symptoms, such as cough, shortness of breath, or changes in her overall health, and report these to her healthcare provider promptly.

Conclusion
The situation is understandably concerning, and it is crucial to approach it with a systematic evaluation. While the possibility of lung cancer cannot be ruled out, there are also other potential explanations for the lung abnormality. Engaging with her healthcare team, considering all diagnostic options, and ensuring close monitoring will be key in managing her health moving forward.

Similar Q&A

Understanding Lung Issues: Exploring Possible Causes Beyond Inflammation

Hello Doctor: Recently, I received my health check-up report and found an abnormality in the left lower lobe of my lung. The outpatient physician explained that it was pneumonia and prescribed medication for me. After a month, I returned for another X-ray, but there was no improv...

Dr. Zhou Ziguang reply Pulmonology
Hello: Based on the described condition, it is not possible to determine a more likely diagnosis. Pneumonia, bronchiectasis, malignant diseases, or other chronic inflammatory conditions cannot be ruled out. Please consult with a pulmonologist for further discussion.

Understanding Lung Fibrosis: What You Need to Know After Abnormal X-Ray Results

Hello, doctor. About a week ago, my father's annual health check-up report from his company came out, and the chest X-ray showed abnormalities, indicating "bilateral pulmonary fibrosis." It was recommended that he see a pulmonologist for further examination. Howeve...

Dr. Yang Wenda reply Pulmonology
Hello: Based on your description, there is only an increase in lung markings (which may also just be an increase in vascular markings). Since there are no abnormalities noted during auscultation, there should not be any significant issues. It is recommended to repeat the chest X-...

Understanding Respiratory Distress: Next Steps for Elderly Care

Hello, doctor. I would like to inquire on behalf of my elderly family member. Recently, my grandmother has been experiencing shortness of breath for unknown reasons, and she often feels breathless in the mornings. She has a history of diabetes and previously underwent examination...

Dr. Hou Angting reply Family Medicine
Hello: I recommend that you visit the pulmonology outpatient clinic for further evaluation. Wishing you good health.

Assessing Lung Biopsy Risks for Elderly Patients with Emphysema

Hello Doctor, my father has a history of smoking for many years and has emphysema. He regularly visits a pulmonologist. During a recent routine X-ray examination, the doctor informed us that there is a white area in the upper left lung that appears to be increasing in size. The d...

Dr. Jian Shuntian reply Pulmonology
Hello: 1. If a definitive diagnosis is needed, a biopsy may be necessary; please discuss with the attending physician if there are any alternative options. 2. At 87 years old, a biopsy does carry certain risks, but they are usually not excessively high; please consult with the at...