What could be hiding behind the fireplace?
The range of reasons is wide. Very often these are the consequences of a previous infection: an area of fibrosis, calcification after tuberculosis, residual changes after pneumonia. There are benign formations, for example hamartoma with characteristic signs on CT. A separate group consists of active infectious processes: tuberculoma, fungal infection, abscess at an early stage. Malignant causes include lung cancer and metastases of other tumors. It is important that with a small size and a typical picture, the likelihood of malignancy is low, and the decisive argument is the stability of the lesion during repeated studies.
- Scar changes after pneumonia
- Calcifications and tuberculomas
- Benign formations
- Fungal infection, abscess
- Lung cancer
- Metastases of other tumors
- Round atelectasis and vascular abnormalities
What does the doctor evaluate?
The radiologist and pulmonologist look at more than just the size itself. The density of the lesion and the presence of calcium or fat in it, the clarity and shape of the edges, the presence of radiance, the location, number of lesions, as well as the connection with the bronchus and blood vessels are important. Ground glass lesions are distinguished separately: they require longer observation because they can grow slowly. Old images are of great value: if the formation does not change over several years, the likelihood of a tumor decreases sharply. Therefore, it is always worth bringing an archive of research.
- Size and its change over time
- Density, calcifications, fat inclusions
- Clarity and radiance of edges
- Solid hearth or frosted glass
- Single node or multiple lesions
- Availability of old photos for comparison
Risk factors
Assessing the likelihood of malignancy takes into account not only the picture, but also the person himself. Smoking, including in the past, and age are of the greatest importance: in a young non-smoker the likelihood of a tumor is low, in a smoker over 60 years of age it is significantly higher. Occupational hazards, contact with asbestos and dust, previous oncological diseases, and family history are taken into account. In regions with widespread tuberculosis, the tuberculous nature of the finding is always considered, so the examination includes appropriate tests.
- Current or past smoking
- Age over 50–55 years
- Previously suffered malignant tumor
- Occupational exposure to dust and asbestos
- Contact with a patient with tuberculosis
- Chronic lung diseases
How to examine
The optimal method is thin-section computed tomography, which is more accurate than x-rays and fluorography. The further plan depends on the characteristics of the lesion: in the case of very minor and clearly benign changes, observation is sufficient; in the case of an intermediate probability, a repeat CT scan is prescribed after a certain period; in the case of a high probability of a tumor, clarifying studies and morphological verification are prescribed. It is necessary to exclude tuberculosis; sputum tests and special tests are used for this. Material for research is obtained by bronchoscopy or puncture under CT control, sometimes a diagnostic operation is performed immediately.
- Thin slice CT scan of the chest
- Comparison with all previous images
- Sputum analysis and tuberculosis tests
- Repeated CT scan within the period prescribed by the doctor
- Positron emission tomography according to indications
- Bronchoscopy or transthoracic puncture
- Consultation with a thoracic surgeon and oncologist
What should the patient do?
The most important thing is not to panic and disappear. Most lesions are not a tumor, but only scheduled observation can confirm this. A missed follow-up shot is the main reason for late diagnosis. Save all studies on disks and bring them to every appointment: without old images, the doctor is forced to prescribe unnecessary procedures. Quitting smoking is beneficial in any case and reduces the risk. You should not undergo CT scans more often than recommended: excessive examinations carry radiation exposure and do not improve the result.
- Strictly adhere to the timing of the control CT scan
- Store all images and reports, including old ones
- Stop smoking
- Inform your doctor about previous tumors and contact with tuberculosis
- Do not prescribe CT scans more often than recommended
- Call ahead of schedule for hemoptysis and weight loss
