right hilum area growth

Portal Forums Lung/Thoracic Cancer General Lung/Thoracic Cancer right hilum area growth

This topic contains 8 replies, has 4 voices, and was last updated by  ttroop7 1 year, 2 months ago.

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February 9, 2016 at 9:24 pm  #1272929    

ttroop7

7-29-15 the contrast CT report said new 15mm right hilar node no pathological effusion. 7mm and 5mm unchanged nodules.
12-1-16 contrast CT scan said no change in 7 and 5 mm nodules. No mention of the hilar node.
2-9-16 Went to ER. Chest pain and back pain worried a pulmonary embolism since have blood clot in thigh. Possible heart attack. Did contrast ct scan. no PE. Did note 2.2cm soft tissue density in the right lung hilum. ER doc said see pulmonologist asap to check for cancer.

Questions:
What does no pathological effusion mean?
Could the hilar node have not been focused on in second report?
What does soft tissue density mean?
Could the nodule in the hilum be causing changing in intensity chest pain, shortness of breath, fluctuating bp and high pulse? I am thinking yes…
I have an appointment with my cancer pulmonologist in two days. Back in July he said the hilar node would be biopsied if it grew, so I am thinking this will be the next step. I just get confused with the terminology because one says hilar node and the other says in hilum.
Anything you could clear up would be appreciated.
Thanks,
Tonya

February 10, 2016 at 5:54 am  #1272931    
JimC Forum Moderator
JimC Forum Moderator

Hi Tonya,

I’m sorry to hear of these latest findings. I’ll try to answer your questions as well as I can, although I’m sure you will learn much more when you see the pulmonologist.

“No pathological effusion” means that the radiologist saw no increase in pleural fluid which could be attributed to a disease process.

It’s hard to say why the hilar node was not mentioned in the second report, but perhaps your doctor will be able to review that scan to see if it was still there and just not noted in the report, or if it perhaps was reduced in size.

A “soft tissue density” denotes a finding of a collection of cells in the lung more likely representing an active process rather than scarring (which would not appear as “soft tissue”).

A relatively small nodule such as yours would not normally cause much in the way of symptoms, although anything is possible due to the specific location of the nodule. Certainly a question for your doctor.

After comparing all of your scans, if a pattern of growth is shown a biopsy would be a likely next step.

Good luck, and let us know what you find out.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

February 22, 2016 at 11:07 pm  #1273041    

ttroop7

This was the majority of what the results said when the contrast ct scan was read…

“When comparing the coronal reconstructions, there does not appear to have been
any significant interval change in the mildly prominent right hilar lymph nodes
between the 2 exams. The suggestion of some interval enlargement as seen on the
axial images is likely due to volume averaging of a couple of adjacent nodes. An
elongated node near the AP window also shows no appreciable change.”

Now… what is volume averaging?
Also, AP window? I looked that up and it says it’s a heart disease…. anyone know if I am reading correctly?
Thanks,
Tonya

February 23, 2016 at 12:24 pm  #1273046    

ttroop7

I also wanted to ask, since the pulmonologist I saw said all is fine, no worries… I am still having a hard time not worrying! I am a smoker who is in a constant state of trying to quit… but I have 8-10 asthma attacks a day some instigated by lighting up, others, I have no reason. I will often have an attack when I re-positioning from one side to the other during the night while trying to sleep or first thing when I wake. The two right lung nodules have been stable for years pretty much. The 1.8cm hilar node is now considered in the AP window, I don’t know if that is the same thing. It also seems when the ER doctor told me when I was there for chest pain and had a contrast ct scan the node was 2.2cm… conflicting results… either way, now the doc says not to worry, all is fine… should I accept that? Should I go for another opinion? Are biopsies done on nodes this size even if they haven’t grown? I have been on antibiotics and preds before both scans regulalry for other reasons… family history, maternal aunt and grandmother dies from squamous cell cancer in that same area. My mom recovered from breast cancer.
Any input would be appreciated… I am worried….

February 23, 2016 at 1:35 pm  #1273048    
catdander forum moderator
catdander forum moderator

Hi Tonya,

I’m sorry you’re worried about these findings. I hope you understand we can’t tell you what you should do. Not only would that be illegal but also impossible. We are here to help people with a cancer diagnosis understand this disease better.

The AP window or ortopulmonary window is a small space between the aortic arch and the pulmonary artery that is visible in the lateral chest radiograph. It contains the ligamentum arteriosum, the recurrent laryngeal nerve, lymph nodes, and fatty tissue. It’s also a term for a type of disease. In this case they are talking about the structure.

Radiologist are doctors who read scans like the CTs you’ve had. Their reports provide the best information. Doctors can only approximate the findings, read reports and often consult with the radiologist about scan findings. I wouldn’t read too much into what the ER doc suggested as 2cm. If you’d like it would be appropriate to ask your pulmonologist about the conflict. A good thing to know is studies have shown that top radiologists read results differently all the time so seeing a cm difference wouldn’t at all be unusual.

An volume averaging talks about the space between one picture and the next in the sequence of images taken. Think of a ball being sliced into pieces like a loaf of bread. One slice will be larger than another. This is what happens with the scan, a nodule can appear larger by several mm depending on where the slice is. This is take into account when the pulmonologist reads the reports and looks to the scan.

The bottom line is if the nodules aren’t growing there’s little reason to think it’s cancer. Most people who’ve smoked or smoke for any length of time have nodules in the lungs that don’t cause problems. As Jim said small nodules like yours rarely cause symptoms. If you’re not convinced you’re getting the best care get a 2nd opinion.

Hope you find peace,
Janine

February 23, 2016 at 4:08 pm  #1273051    

cards7up

And if you’re uncomfortable with your doctor, definitely get a second opinion. Most of us do!
Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

September 9, 2016 at 6:57 pm  #1288563    

ttroop7

Hi all!!
I did take your advice and got a second opinion. That got me to someone who was a cancer specialist who said I was fine. Yet could not walk from one room to the next. So I went just two weeks ago to another specialist, two actually, one cancer and one just pulmonology. (if that much matters). Either way.. I ended up in the hospital this past week on 3.5L of o2 and still only hitting 91% which always lessened on movement.Now I am told to follow up some more… the paperwork in a nut shell… says likely IPF. I have reticular honeycombing throughout both lungs. . but at the same time it says I have enlarged pretracheal, subcarinal and bilateral hilar lymph nodes all measuring up to 1.7 cm. I also have bilaterial upper lobe predominant patchy ground glass opacities including peribronchial groundglass nodules (if someone knows what this would mean, please say) Also the same ground glass nodules in the right middle lobe as well. I also have interlobular septal thickening, not sure of that one either. with an upper lobe prominence.

Either way.. I now have a visiting nurse coming tomorrow because the hospital sent me home without oxygen!!! I also need help with basics…
Any input anyone has about any of this, I am willing to listen!! I was told by new cancer doc that my lungs are not healthy enough to actually biopsy….

Thanks,
Tonya

September 10, 2016 at 6:42 am  #1288569    
JimC Forum Moderator
JimC Forum Moderator

Hi Tonya,

I’m am sorry to hear of the suspicion of IPF, although that is outside the specialization of the GRACE faculty. Ground glass nodules are seen as hazy areas on a CT; these can represent cancer but can be caused by other factors as well, such as infection or inflammation. As far as the enlarged lymph node, there can be many causes for these other than cancer.

From Radiology Illustrated:

“Interlobular septa are sheetlike structures 10‚Äď20-mm long that form the border of the secondary pulmonary lobules. The septa are usually perpendicular to the pleura in the lung periphery. They are composed of connective tissue and contain lymphatics and pulmonary venules. On CT scans, diseases affecting one of the components of the septa are responsible for thickening and thus cause the septa [to be] visible.”http://link.springer.com/chapter/10.1007/978-3-642-37096-0_16?no-access=true

Either fibrosis or cancer can be the cause of this finding.

I hope that you get some good answers and symptom relief from further follow-up.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

September 10, 2016 at 9:14 am  #1288576    

ttroop7

Hi thank you so much Jim C for your response. I did forget to mention that I had very thorough blood cultures done and it was found that there was no actual infection I was fighting. Like no pneumonia or anything like that treatable with antibiotics.
It is so hard, as you can see I have been fighting with doctors telling them how very sick I am for quite some time. Answers are good because that can lead to the proper treatment!!
I will keep in touch. My mom’s side of the family had the cancer of the nodes in the hilar area… so I am not ruling that out that is for sure!

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