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Questions about lung nodule and pavm !!!


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Hello all. I'm new to his forum. 

I was having sharp sharp chest pain in my left and right chest and upper back for weeks... I thought it was a heart attack. I'm 29 year old woman in good health. My heart was checked out multiple times my blood is normal and fine. Finally I got a ct scan that showed 5 mm lung nodule on mid upper right chest with adjacent pavm. 

My pain has worsened everyday now I feel it in the mid chest and upper arms at night .. I can't sleep much. It's a sharp shooting pain that comes and goes. I thought it could be gall bladder or nerves but it's not. 

I smoked for two years 8 years ago literally like 2 cigs a day and my uncle died of stage 4 lung cancer non small cell. He smoked his whole life. 

I don't know what to do because it's been 4 weeks and no answers. The avm I might have surgery , an embolization so it doesn't rupture or cause a stroke however I want to get my nodule biopsied but I think this is a risk with having avm next to it. I need answers if biopsy is dangerous w a pavm. I haven't seen a pulmonoligst yet and I'm so scared to death I'm dying. I know it would be rare but my symptoms are worsening and I have no other expalanations...wondering if anyone has experience with having a pavm and a nodule and how to go about getting a biopsy ... I'm worried about pet scan and all the radiation. I know 5 mm is tiny but couldn't it cause symptoms??? Any info is appreciated thank you!!!!!! the symptoms over 4 weeks is what concerns me the most. 

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Hi, Emma,

A 5 mm nodule is SO small you would be unlikely to have any symptoms related to it.  Furthermore, it's most likely too small to biopsy.  Nodules can be many things, and the vast majority are not cancer.  They represent inflammation or scar tissue or similar things.  I've had a few nodules that appear/disappear on subsequent scans, and nobody seems too concerned with them.  My one nodule that turned out to be cancerous grew over time and had a distinctive spiculated (with points like a star) appearance.  

If you're concerned about the nodule, do see a pulmonologist, but know that the likely recommendation would be, at most, to have another scan in a few months to see if there are any changes.  Maybe a pulmonologist might have other ideas about the source of your pain.

I know nothing about PAVM, but it sounds like your doctors are on top of that.  You might also want to consult with a neurologist, to see if there's a nerve-based reason for the pain you're experiencing

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Hi Emma, 

I agree with Lexiecat that such a small nodule is unlikely to be, by itself, the source of your pain and it may be too small to biopsy. Sometimes PET scans don't light up with small slow growing nodules (mine didn't). If you haven't already seen a pulmonologist, I suggest you get a referral and see one right away. He or she should be able to interpret the significance of the nodule and the adjacent arteriovenous malformation and determine whether they are related and/or whether either is related to any other disorder. It seems like with the increasing pain you should be able to get answers sooner rather than later.  If you already have a pulmonologist and aren't getting adequate answers, you might consider asking for a second opinion. Let us know how this goes.

Bridget O

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Well, yes, they can--most lung cancers do start out with small nodules.  But the thing is that given the number of other possibilities, a very small nodule is relatively unlikely to be cancer.  And the point is, it's very unlikely to be causing your symptoms.  For lung cancer to cause pain, the mass generally has to be quite large.  

So talk to the pulmonologist about maybe having the nodule re-checked in a few months, to put your mind at ease, but don't assume it's likely to be cancer.  

I do hope they can get to the bottom of what's causing the pain.

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Welcome here.

I've just reviewed the dialogue you've had about small nodules and cancer.  Here is my go to resource that discusses various lung nodules and the reason they occur.  As you can see from the reference, there are many non-cancerous causes for nodules.  Five millimeters is about the width of an eraser on a lead pencil. I'm almost certain it would not be the cause of your reported pain.

Stay the course.


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