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1.5-cm mass protruding from left AP window

xrylump
Posts: 6
Joined: Jun 2010

I am a 42-year old male, non-smoker, with no history of respiratory
problems. I was recently diagnosed with bronchitis/COPD/asthma which
has been causing shortness of breath and bronchospasms (asthma
attacks) over the past month. Started as a cold/congestion, evolved to
cough, then breathing problems (inflammation). Currently being treated
with antibiotics and advair & xopenex, and recovering (symptoms mostly
gone, mild tightness of chest, mild chest pain remains).

As part of diagnosis (to rule out pneumonia), doctor ordered chest
X-Ray last week. I have detailed the findings below. Basically, it is
abnormal with a 1.5-cm mass. What exactly is a "ductus aneurysm"? What
are the chances that this "mass" is simply due to the
infection/congestion because of bronchitis? Is that what "adenopathy"
is? Could it just be inflammation of the AP window lymph node?

A chest X-Ray taken in April (as part of routine check-up) was normal,
though there is always a chance they missed the "mass". Is that too
big to "miss"? Can it grow 1.5-cm in a month (if it is a tumor)?

I want to wait at least a month for my bronchitis to fully clear
before taking another X-Ray, and possibly CT scans etc. I am
self-insured with a high-deductible insurance plan, so I will be
paying out of pocket. Hence, the hesitation in proceeding with the
recommended CT scans. Thanks for any suggestions on the odds of this
"mass" just going away with the resolution of the bronchitis.

=== Chest X-Ray report ====
Findings:
Two views of the chest were obtained and demonstrate a 1.5-cm mass
protruding from the left AP window. A ductus aneurysm would be a
consideration but confirmation would require a CT chest with contrast
with attention to the aortic arch and AP window. A mass or adenopathy
cannot be excluded. Pulmonary arteries are slightly prominent. Lungs
are midly hyperinflated and hyperlucent. Correlate with any history of
COPD or asthma. No focal infiltrates or effusions noted. Broad based
minor mid dorsal dextroscoliosis curve is noted. Heart size is small.
Impression:
There is a left AP window 1.5-cm mass possibly a ductus aneurysm. This
could be further confirmed by contrast enhanced CT chest study. Other
alternative would be to compare this with old films to assess for
stability. Adenopathy or mass of other etiology cannot be excluded.

medi_2's picture
medi_2
Posts: 511
Joined: Aug 2009

I'm pretty sure a few people here were talking about bronchitis giving false results on a cat? Probably best to let it clear up before getting another one. (if it is safe to do so of course!)
Good Luck!
Medi

xrylump
Posts: 6
Joined: Jun 2010

thanks, i also read on the internet that bronchitis can give false readings on ct/pet etc.

ilvnazoo
Posts: 3
Joined: Jun 2010

perhaps others will not agree, but please do not wait on this to clear up. My husband had a similar beginning to his story. First it was bronchitis, then it was a small area of pneumonia, then supposedly it was all cleared up. It wasn't gone and the mass grew rapidly. In three months my husband had lung cancer with a tumor the size of a small football. 9.5cm by 6cm.

Praying yours is not what his was.

Lisa

xrylump
Posts: 6
Joined: Jun 2010

Lisa -- Thanks for your reply and your concern. My symptoms are all cleared up now thanks to the antibiotics, so I am convinced it was just an infection. Also, X-Ray indicated no penumonia (my doc said so as well).

Just curious -- were there any other symptoms due to the tumor once the bronchitis cleared up? Why did he go back if it was all cleared up? Thanks.

ilvnazoo
Posts: 3
Joined: Jun 2010

My husband's main symptom were weakness and shortness of breath on exertion. He also had night sweats and low grade fever.

Take care,
Lisa

augigi
Posts: 89
Joined: Dec 2009

Adenopathy is swelling of a gland (usually lymph node) ie. lymphadenopathy.

Ductus aneurysm is a thinning in an artery between the pulmonary artery and aorta (this duct usually closes at birth).

Honestly, I wouldn't wait. I can't imagine how bronchitis could cause a "mass" to show up, unless there was serious lymph node enlargement due to the infection. That would be v. unusual.

How much will the CT be? Can you just go get a repeat CXR and see if it still shows up, then think about CT?

Cause really, if it is a tumour or aneurysm, you don't wanna wait and let it grow.

xrylump
Posts: 6
Joined: Jun 2010

@augigi: Thanks for your response. My bronchitis was cleared by antibiotics so it was certainly an infection. When I googled Lymphadenopathy, I got back results that indicate that infection can cause such "masses". So, I don't understand why you say it is unusual.

Before the bronchitis happened in May, I had a routine physical in April (outside the country). The chest x-ray taken as part of this physical was apparently normal (so was the entire exam). Granted that it is possible that they made a mistake or didn't take a good enough image. But if the x-ray was taken correctly, it would seem strange for a mass to suddenly show up in a month. The new x-ray (with the mass) was taken in early June (basically a month after).

I am planning to get a repeat CXR, but I want to wait till all inflammation/infection etc. is cleared from my chest. While all my bronchitis symptoms have cleared up, I read on the Internet that it could take up to 3 months for everything internal to come back to normal. I read that such infection/inflammation can confuse a CT scan or even a PET scan, and create unnecessary panic. So, the plan is to wait for 3 months (assuming no symptoms in the meantime), and then take a repeat CXR to see if the same mass is seen. I dunno if 3 months is too long to wait -- that's what I am trying to determine by posting here.

I have never smoked or been around smokers or other pollution, so the odds of lung cancer would seem small. I am symptom free as well. Anyways, I will give it thought. More than the money itself, I just don't want unnecessary tests, stress and panic. The CXR report is so vague and non-committal that I am hoping to get some informed opinion on the Internet.

medi_2's picture
medi_2
Posts: 511
Joined: Aug 2009

Hi! I think the internet is a wonderful tool but I would take everything i read with a grain of salt. I asked my Doctor for a list of safe sites (this one was on the list ;)).
I would rather put my life in the hands of trained professionals that I can speak with face to face.
Just my 2 cents.
Medi

cabbott
Posts: 1046
Joined: Aug 2006

Cancer doubles at varying rates. Some are highly aggressive and double every 22 days (I've heard of aggressive breast cancer that was this quick but that's rare). Some are fairly slow and double every 210 days. Some cancers take even longer. Doctors take such rates in account when they order repeat chest scans. My sister (a real honest to goodness doctor) told me that it is standard for lung scans to be placed 3 months apart when they are trying to determine if something might be cancer. If it doesn't grow, they order another scan 3 months down the road. If it did grow, they look at it from all sides and try to determine what it is. It isn't always cancer even if it grows. The only way they can tell for sure is to get some cells under a microscope.

Not to give you nightmares, but only 9 out of 10 cases of lung cancer are associated with smoking. I'm one of the 1 out of 10 cases. They found mine after I failed to respond to antibiotics for a respiratory infection. Cancer kinda' ruins your immune system. After the operation, I finally got rid of the pneumonia and bronchitis.

Mind you, you responded to antibiotics, so you are probably okay. But doing a recheck would be a good precaution. You might talk with your doctor about doing a second chest xray instead of a CAT scan. If the spot is gone, there is no need for the CAT scan. If it is bigger, you might want to do a PET/CAT scan which gives the surgeon lots more information needed for treatment decisions. Yep, that would probably be even more expensive, but you would need it anyhow before surgery (if things look bad, which they just might not). If you did the xray, you would also be saving yourself some radiation exposure as well as some cash. So check with the doctor about what he really needs to have to diagnose you. He might trying to check up on another possibility other than cancer that the CAT scan could pinpoint. CAT scans do give 3-D pictures of everything in your chest and make it possible to look at lots more than just your lungs. So ask.

xrylump
Posts: 6
Joined: Jun 2010

@medi_2: I haven't seen a specialist yet -- my PCP was treating my bronchitis. I am supplementing his advice by reading on the Internet.

@cabbott: Thanks for the detailed info on cancer and bronchitis -- I am watching to see if the bronchitis returns (as one sign). "The plan" is mine, not the doctor's. He advises an immediate CT scan. I want to wait. But I will likely do another CXR soon, maybe next month. CXR is much cheaper than a CAT, so I can even do a couple more CXRs (spaced over 3 months), before the CAT. I am sorry to hear that you were the unlucky 1 in 10; I am hoping I am luckier than that.

augigi
Posts: 89
Joined: Dec 2009

I don't really understand why you are asking - you have clearly made up your mind already.

hartmann's picture
hartmann
Posts: 26
Joined: May 2010

I would hate to see you wait and take the chance that it could be cancer. I put off going to the doctor because of money and I also had had a full physical less than a year prior. My only symptom was some very minor chest pain (not even where the tumor was).Now I wonder if more could be done if I hadn't been so stubborn and just gone in earlier. We did a chest xray as a fluke to "ease my mind" because my sister was being treated for lung cancer. The doctor and I thought the pain was probably stress related. My "spot on my lung" turned out to be 2.5cm nsclc tumor. This really didnt seem to be to serious until they did the ct scan and found multiple large (6cm) tumors in my liver and multiple areas of lymph involvement. Now I just kinda laugh when I see the hospital bill for chemo treatments! I wish you the best and will say a prayer that you will be fine

Penny

xrylump
Posts: 6
Joined: Jun 2010

Thanks to all of you for the warnings. I was wrong about the bronchitis fully clearing up. My celebration was premature -- the cough is already returning. So, the antibiotics did not solve the problem.

I am going to take this more seriously and schedule a CT scan soon. Perhaps I am not so lucky. If this is cancer, waiting is a bad idea indeed. I am glad I posted here -- you changed my mind rather quickly. Thanks again.

hartmann's picture
hartmann
Posts: 26
Joined: May 2010

Happy to know you are going to have this checked out further. Let us know how everything turns out.
Penny

mamacita5's picture
mamacita5
Posts: 254
Joined: May 2010

Sooner than later is best :)

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