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Follow up of Bilateral Pulmonary Nodules (1.5 Years ) Now Experiencing Neurological symptoms


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                                                                  My Disease History

Name : Swapon Kumar

Age : 29 Years 

Marital Status : Married

I Share  my health conditions. At Mar 2016 , I experienced some burning and localized type chest pain in left chest area .After taking several investigation like Ecocaridography and Nuclear stress test  it was confirm that it was not from Heart .Doctor told me to GERD ,musculoskeletal or something like that .Also perform upper gastro endoscopy in May which came back normal. But in Jun 2016 I found my left Supra Clavicle  region slightly higher than right .After that one doctor recommend me to perform MRI. Findings of MRI Shows no Lymph node .Only 3 mm thickness in transverse process muscle body in Brachial Plexus region Higher than Right area.

After that because of chest pain I take another opinion who recommend  me to perform CT and after performing that with 5mm thickness pre and post contrast IV  findings are  multinodular  densities shows in both lung field at October 13,2016.One Subcentrimetric  Sizable nodule in left lower lobe at Lateral Basal Segment .(Not mentioned Size )

In November 2016 I have some cough with blood sputum in morning . So Perform Skin tuberculin test which come back +8 mm and Two Consecutive acid first Bacillii (AFB ) Test show negative result .Then perform another IV contrast CT with 2.5 mm MPR Images Result Shows :

(21 st November 2016 CT Date ) : CT-1 (Findings )

Right Lung :  

-small round 3.6 mm nodule seen in the peripheral part ,anterior segment of the right upper lobe with smooth well defined margin with surrounding  lung parenchyma.

-4 small irregular shaped nodules ranging from 3-4 mm seen in posterior basal segment ,located adjacent to each other surrounding lung parenchyma .

Left Lung :

-solitary, round 9.4mm sub pleural nodule is seen at the lateral basal segment of the left lower lobe ,well defined margin surrounding  lung parenchyma.

(12th  February  2017 CT Date ) : CT-2 (Findings )

 No appreciable interval changes as compared to the previous study, the previously seen nodules shows no change in size nor in number or location.

After another six month follow up I take appointment in another ct. In the mean time I experience several symptoms like Bad headache, serious Back pain , some swelling in LUQ area but Performing ultrasound ,no organomegaly  or abnormal pathology seen.

(24th  July  2017 CT Date ) : CT-3 (Findings )

Scan through the chest shows a well defined nodule in the anterior segment of the right upper lobe.No intraregional calcification or cavitations noted. It measures about 6mm.Another pleural based nodule noted in the left lower lobe along the postero lateral chest wall. It contain foci of calcification and measures about 9mm in size.

Bilateral lung nodule, one in the right upper lobe and another one in the left lower lobe as described. Further workup advised.
In comparison with the last CT dated 12/02/17,the size of the right upper lobe nodule shows increase in size. However, the nodules noted in the right lower lobe as mentioned in the previous report are not visualized in the current study.

21st Jan 2018 pet CT Date :)18 F  -FDG PET/CT SCAN  Findings :

Chest:
There is a basal left lung nodule 9.7 mmx9.4 mm with no significant FDG uptake. Another smaller sub centimeter lung nodule with no FDG uptake noted at the right middle lobe(4.3mm).
The heart is within normal limits and there is no pericardial thickening or effusion.  There are small multiple paratracheal lymph nodes with no FDG uptake.

Impression:

 Non- hyper metabolic pulmonary nodules in the lower lobe of the left and right middle lobe of the left lung. Further correlation is needed.

 

Blood Profile Count History :

All other parameter of total biochemistry remain normal except uric acid shows high maximum time. I also perform RF Factor which came back normal.My lymphocyte count maximum time in near the top and some times higher than range .But RBC ,WBC ,Haemoglobulin within normal range .

This is my disease history. Some pain in right upper rib cage sternum area when bent and experience

1)Titubation ( With severe Dizziness when close Eye)

2) Pain in Middle of Backbone

3) Occasional neck Stiffness

4) Feeling Ataxia when carry little weight in Hand

I have also Perform  Brain CT scan due to this problem on 26 th April 2018  which was unremarkable findings and only spasm on neck muscle .Also Perform Basic Ear and Eye Test which reveal no abnormality .Also Perform a Brain  MRI  (contrast )   which came back unremarkable.

I also perform crp test more than 3 times in last year and two times in current year which come within limit and result within 2.0. What should be the next point now this stage what should I do from my view point ????`

 

ct1.jpg

ct3.jpg

pet ct 1.jpg

Right lobe-1.jpg

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Hi, Swapon, and welcome.

We aren't medical professionals here, so none of us can really be of much help in figuring out what might be going on.  I'm not sure what kinds of doctors you've been consulting with--pulmonologist, neurologist, etc.  What are the doctors saying about your test results?  

There are lots of causes of lung nodules, and most of them are not cancer.  It could be that you've had infections in your lungs, for instance, which could also cause the chest pain and coughing up blood.  

I guess I'd talk to a pulmonologist about whether there should be continued monitoring of the lung nodules.  There is some radiation-exposure risk associated with testing more often than is necessary.  Right now you've been following these nodules for over two years with no significant changes, it sounds like.  There may be absolutely nothing to worry about.  

Sorry not to be of more help.

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HI Swapon. 

Welcome here. I'm sorry to hear about your health concerns and  that you haven't been able to get a diagnosis. It sounds very frustrating. I have the same question that LexieCat has about what kind of doctors you've been seeing. If you haven't seen a pulmonologist, my first suggetion would be that you see one. My pulmonologist was able to tell me a lot from looking at my CT scan. She told me that one lung nodule was very suspicious for cancer due to its shape.She thought it was probably a primary lung cancer and not a metastasis from a different cancer I had previously. This turned out to be correct.   She also told me that scarring in my lungs was likely from valley fever, an illness I was never aware that I had. This illness occurs where I grew up, but not where I have lived as an adult. So I thought she was very knowledgeable. This is why I recommend a pulmonologist.. If you have one and he or she can't answer your questions in a way you think is reasonable, you might want to get a second opinion. I'd also suggest seeing a neurologist, if you haven't already.

Best of luck getting some answers! Please keep us informed about what you find out.

Bridget O

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Thanks a lot for your kind reply . I am also in a fix regarding my health condition . I also take appointment with a doctor specialist in respiratory medicine . My Nodules Found incidentally  at October 2016 due to pain in heart region . Then due to blood tinged sputum doctor told to perform another ct in November 2016 which mentioned size left one 9.4 mm and right one 4 mm (5 mm ct thickness)..Third hrct told stable in size and shape .(Feb 2017)..These Respiratory medicine doctor told to done another last ct in august and told likely benign ...after that at july 24 2017 done another  HRCT which told left one 9 mm and right one growing 5.7 mm ..After visiting doctor ,he told to do an pet ct to investigate its metabolic profile through pet ct ..which shows no significant uptake 9.4*9.7 mm and the right one 4.6 mm which non hyper metabolic in nature . But From April 15 Titubation and truncal ataxia started which is now continuous.Brain mri and ct Normal ...Thyroid hormone ,Prolactine normal ...What should I need to done in this situation nodules nearly stable ..is I need to insist for Another Pet or Biopsy ? Any of us experiencing same symptoms ...Please suggest. 

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I think only a doctor can recommend whether further followups on the nodules are needed.  Sounds to me like your primary symptoms right now are neurological, which may have zero to do with your nodules.  I've had neurological issues (slight numbness in fingers/toes) for over 15 years--way before my early/tiny cancer was discovered.  I've had a number of MRIs and tests and the docs have never figured out the cause--I've just learned to live with it and it hasn't gotten significantly worse.  

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