My Moms CT Results, help understanding???

jboling0399

Sorry in advance for the long post. First I have summarized the last 2 day’s events anmd start with mom’s CT Results (toward the middle of post) from yesterday. Afterward, I summerize her history after, there is substantial history. My question to those out there who may understand these findings, is does anyone think the above CT scan results indicate there may be progression of anything cancer related? Or any other condition that could be involved? In mom’s history I explain 2 prior CT scans revealed a 2 mm Cavitory Lesion that is being treated by a Pulmonologist as another bout of pneumonia, it looks to me the Lesion has grown to from 2mm to 3mm, along with other NEW findings such as the lymph node involvement that have never been found before. The Dr. messaged this morning to say the CT scan actually looked better????This makes absolutely no sense at ALL!!!! l am looking for feedback or any help understanding what this CT findings mean and what I should do to press for more aggressive or new treatment for my mom if need be? I feel like this has been going on way to long (2 1/2 years!!!) and the doctors are treating my mom as if she has stubborn pneumonia that will get better by treating the same way now as they have the last 2.5 years. I am very frustrated and scared. I just want my mom to want to live again, she is so tired and ready to give up. I would be grateful for any feedback or advice!!!!

TECHNIQUE: Multiple helical images were obtained at 5 mm slice thickness from the level of the thoracic inlet to the adrenal glands. Additional sagittal and coronal reconstructions were obtained.

Radiation dose reduction was utilized (automated exposure control, mA or kV adjustment based on patient size or iterative image reconstruction).

FINDINGS: The thyroid lobes are atrophic and grossly unremarkable. Anomalous right subclavian artery. There is mediastinal adenopathy with a 1.2 x 1.9 cm lymph node, an AP window 1.0 x 1.0 cm lymph node. There are coronary artery calcifications. The esophagus appears normal. The tracheobronchial tree appears patent. The heart is nonenlarged. No pericardial effusion. Lungs demonstrate biapical pleural thickening and patchy peripheral nodular opacities right upper lobe on image 27, left upper lobe and right upper lobe image 20, lingular nodule measuring 3 mm on image 40 with an adjacent 2 mm nodule, a spiculated right middle lobe mass measuring 1.0 x 0.8 cm within the right middle lobe. The breast tissue and both axillae appear normal.

BONES: Cervical spine plating. Thoracic spondylotic changes. Unremarkable sternum.

IMPRESSION:

1. PATCHY NODULAR INFILTRATES, SOME OF WHICH HAVE SPICULATED AND PERIPHERAL LOCATION WITH ADENOPATHY. FURTHER WORKUP AND A FOLLOW-UP EXAM TO FURTHER DOCUMENT CONTINUED RESOLUTION.

HISTORY: My mom who is 70 yrs old has been fighting chronic pneumonia for 2.5 years. She has had a history of smoking for 50 years. She came down with pneumonia and would be in the hospital sometimes a couple of times, get well for a month or two and then would get sick again. Her first CT scan 2.5 yrs ago showed small nodules in her lower lungs they just wanted to watch. Then early summer 2023 after getting ill again she was referred to a Pulmonologist, he diagnosed her with COPD and treated her for the pneumonia. Pneumonia again in September of 2023, pulmonologist ordered new CT, showed a Cavitory Lesion 2mm in upper right lobe, report said it had irregular boarders pointing out it could be possible malignancy or infection. Treated w/ antibiotics same as prior bouts of pneumonia. January 2024, guess what pneumonia, new CT Scan showed same Cavital Lesion but now 4mm. Her symptoms over the last six months have also become more severe. She now has to be on oxygen all the time. She has lost 50-60 lbs in the last 6 months. She is confused all the time and has severe short term memory loss. She looks awful. Her skin is gray with terrible black under eye circles. My once incredibly active mom has been sleeping all night and all but maybe 4 hours during the day. Taking a shower wears her out for 2 days. She had been on oral antibiotics for two weeks beginning early January, but after worsening symptomless had a follow up visit earlier than planned on 1/25. This visit I pressed for a biopsy, or treatment that would be more aggressive that would help her actually get better. Although the PA agreed it was time for a biopsy she said they had not done one yet because Lung Cancer did not normally present as a Cavitory Lesion but still felt something else needed to be done. She had to discuss with Dr. and called later that day and said the Dr. wanted to try 3 more weeks of antibiotics because the chest x-ray done the same visit still showed the lesion was there but said it “might” look a little better. I was upset but said ok. I read over the next two days everything I could read on Cavitory Lesions and chronic pneumonia and what I read said contradicted her statement that lung cancer doesn’t present as Cavitory Lesions. There are some that don’t but some cancers where CL is the primary way LC begins. So that’s the history in short. Current situation- mom is on day 6 of antibiotics. Dr. advised me to take her to ER yesterday after I called to tell him AGAIN that she seemed to be getting worse she’d O2 sat was worse and her lungs sounded worse and she literally was not able to get up and do anything. CT completed at ER. The ER Dr. indicated that there were new issues on her CT scan yesterday when comparing to previous CT scans. As I stated above, it looks to me the CL is bigger from 2mm to 3mm, she has plural fusion in both upper lobes, the CT also mentions opacities that haven’t been mentioned before. As well as the new lymph node findings. This along with her worsening symptoms don’t correlate with the Drs. message to me this morning that this CT scan actually looks better. Of course I have no experience when it comes to these issues, so any feedback would be appreciated!!!

3hearts

.”Lungs demonstrate biapical pleural thickening and patchy peripheral nodular opacities right upper lobe on image 27, left upper lobe and right upper lobe image 20, lingular nodule measuring 3 mm on image 40 with an adjacent 2 mm nodule, a spiculated right middle lobe mass measuring 1.0 x 0.8 cm within the right middle lobe.”  

It does sound like it could be cancer. My husband was diagnosed 9/11/23. He had a 1.2cm spiculated mass as well with pleural thickening and had metastasis to adrenal gland. A biopsy confirmed it. I would definitely ask as many questions and get a biopsy done. It’s best to try to get a full body PET scan which shows active cancer anywhere in the body too. I hope for the best for your mother.

jboling0399

https://csn.cancer.org/discussion/comment/1713094#Comment_1713094

Thank you so much for responding. I will be thinking about you and your husband. I defiantly think that’s what we are looking at. She has a Dr. appointment with the pulmonologist this morning. This makes me more confident about pushing the doc to get something done and quit all this waiting around. Have a great day. Thank you again!

3hearts

Thank you so much! If you ever have any questions or need to talk, I’m here. It’s a lot to comprehend and to go through. It’s been the most difficult time for us. You have to advocate for your mom for sure. Push the Dr as much as you need to! I hope all goes well for her.

jboling0399

https://csn.cancer.org/discussion/comment/1713116#Comment_1713116

I can’t imagine how you must feel and what you’re experiencing. I will say a little prayer everyday. I appreciate it again, we met with the doctor and I could just tell for whatever reason he isn’t going to take action until, well all I can think is until there is other chance it can be anything but cancer. I have really contemplated what his motivation is for glossing this over as nothing, when it so obviously it could be something. At moms appointment yesterday he went out of his way to make sure she understood he didn’t believe she had cancer but when she started crying in relief and said so you are saying I don’t have cancer to which he said no I am not saying that. I am saying we are treating this as infection right now. Then he went on to show her that the cavitol lesion was smaller and in padding nonchalantly point out the new mass in her middle lobe, he said and oh and here is a new mass but it should be gone at the 3 month CT scan when we confirm the cavitol lesion is gone. I asked if it was the one in her middle lobe and he looked at me kind of surprised and said yes, then right back at mom and said I feel sure these changes are just infection. I asked him if he saw anything about this new mass and the changes in her lymph nodes that could possibly indicate cancer? He said not right now, but we will make sure they have cleared up on the follow up CT. I could just tell he had no interest in prevention or confirmation of his guessing about something so dangerous. I called MUSC’s cancer center yesterday and set up a 2nd opinion yesterday. It was crazy how quickly they want to see her after reading the CT report, it makes me want to know if it’s concerning to them why it’s not concerning to the pulmonologist? I mean she is on Medicare, they don’t make any more money??? I hate conspiracy theories but the other answer is the pulmonologist has some bias based on her age and that she was a smoker who is doing great but still struggling….??? It’s a scary question. Did your husbands doctor move forward with intervening care immediately after his CT?

3hearts

My husband was diagnosed on 9/11/23. Biopsy was done 9/12/23. It confirmed that it was lung cancer that had metastasized to his adrenal gland. His first oncology appt was 9/15/23. The Dr’s did not drag their feet and also I stayed on top of them to make sure everything got done ASAP. The only thing that probably made everything go fast was that I had taken him to the ER and it was an accidental finding. It has been devastating for us. His cancer has spread more even after some chemo/immunotherapy/radiation.

I hate that lung cancer is an automatic “smoking” disease. My husband quit smoking over 16 years ago. He’s been in perfect health all of his life. We are only in our 40’s. This shouldn’t be happening. I hope your mom is ok and her tests come back fine. Thank you for the prayers!

eDivebuddy

Lung cancer does not present as a cavitary lesion. Lung cancers are solid. A cavitary lesion is a cyst with a thick wall. Most of the CT scan points to a chronic infection. But one is worrisome. "spiculated right middle lobe mass measuring 1.0 x 0.8 cm". that is typically how lung Cancers present if they are cancerous. Not all are.

Are there parts missing from your CT report? It doesn't mention a comparison. Also the middle lobe lesion is not mentioned in the impressions. This would lead me to believe it's NOT new . And further resolution means what ever they are doing is working and to continue monitoring. What ever it is she needs the infection to get under control before anything. There are no treatments for prevention. Prevention is a life long commitment with no guarantees. Having a lung puts you at risk for lung cancer.

A biopsy is not to be taken lightly. There are risks involved and they are not going to do one while your mother has an infection. Especially not one of the lung.

Getting a second opinion is always a good thing. Especially the center you've chosen. They are going to say the same thing as your current pulmonologist. Maybe in a different way . And maybe your mom would feel more comfortable with someone else. But that's up to your mom.

Because my daughter doesn't like my oncologist is no bother to me. I love him.