Hi,
I recently had a chest ct scan, which read as follows:
2.4 cm nodular infiltrate present in perihilar region of right upper lobe, with tree in bud infiltrate surrounding. Calcified granulomas present in lower right lobe. Taken together, the findings are highly suggestive of infection granulomatous disease.
I've had my doctor and a lung specialist look at it, and they agree that they think it's just some type of infection, thinking it's some type of fungal infection. I have a low grade fever that I've had for a few weeks and chest pains that have been getting worse. I am also 25 years old, which makes me think that they are not even considering the possibility of lung cancer. I trust the doctors, but it feels like 2.4 cm is pretty good size, and makes me pretty worried. Also, the I thought that if the granulomas are calcified, that they are old and thus shouldn't be considered when making a diagnosis for a seemingly active nodule. Does this sound like a cancerous nodule? Or do you agree with my doctors? I'm just looking for as many opinions as I can get. Thanks,
-Riley
Reply # - August 4, 2017, 09:51 PM
Hi Riley,
Hi Riley,
Welcome to Grace. I'm sorry about this worry and hope you won't need any intervention. We can't give opinions but we can offer information on the subject.
A CT scan can normally detect a calcified granuloma for what it is. A calcified granuloma looks different than cancer on a scan. You're right that calcification suggest the area has been around for a long time, even years. Radiologists are highly trained to read scans and right reports. It would be unusual for a radiologist to write something in a report that isn't certain. In fact it's pretty common to see wording like, "could possibly represent" when there's something there that isn't clearly one specific thing. So when the write with specifics it's a good indication of surety. You've also had 2 other doctors look at the scan. While a pulmonologist isn't specifically trained to interpret scans they see them everyday and get pretty good at knowing what they see.
You've had 3 doctors including the radiologist see the same thing. I'm not sure The quote below is from the Mayo Clinic website. It may help understand what's going on.
"A doctor may suspect a diagnosis of granuloma by a plain chest X-ray or, if the granuloma is not apparently calcified, by computerized tomography (CT), which can detect the calcium that isn't evident on a plain chest X-ray. The images of affected tissue usually show scarring and calcification characteristic of a granuloma.", http://www.mayoclinic.org/granuloma/expert-answers/faq-20057838
I hope you do well.
Janine
Reply # - August 5, 2017, 07:19 AM
Thanks for your reply Janine,
Thanks for your reply Janine,
I'm not concerned about the granulomas because to my understanding they are pretty clear in a ct scan. What I'm concerned with is the 2.4 cm nodular infiltrate that the radiologist found in the right upper lobe of my lungs. He said it has a tree in bud extension which I hope means that it's an infectious response.
Thanks,
-Riley
Reply # - August 5, 2017, 09:07 AM
Riley,
Riley,
What does tree in bud mean?
During my three years of diagnosis, treatment and scanning, I have found that radiologists will actually write more possibilities to cover themselves from being accused of missing something. Also, many features can look like infection on a CT scan, but I am not a fan of treating it as if infection or a "wait and see" approach. I was asymptomatic when they initially treated me as if it was infection, but if you do have some fever and chest pain, bacterial infection would be an easy remedy. I'm not sure if a fungus would have to be sampled and evaluated. No, you are not in a high risk category for lung cancer, but it's simply not true that only older people who smoked get lung cancer. I do encourage you to get a definitive answer. Could a bronchoscopy reach the perihilar (?) region?
Good luck with getting the answers you need. Let us know if you need any other support.
Cindy
Reply # - August 5, 2017, 02:50 PM
Hey Cindy,
Hey Cindy,
A tree in bud is a presentation commonly seen on ct scans, and I think that normally it indicates some type of airway disease, such as mucus or puss in your tubes. From what I understand, normally it indicates infection, but it can present in malignant tumors as well, so I'm not convinced of anything yet. \Yeah I'm definitely with you about the waiting and seeing approach. That's just not my style. I'm sending my ct around to get as many opinions as possible and have an appointment set up with the lung specialist. 8-) Hoping if it's anything mischievious that I'll cut it out early enough. Cindy, could I ask what you were diagnosed with, and what were your symptoms?
-Riley
Reply # - August 5, 2017, 05:02 PM
Riley,
Riley,
I had no lung cancer symptoms. I still have no lung cancer symptoms. The absence of symptoms is why lung cancers often are not diagnosed until the disease is advanced or spread. I was diagnosed with stage IV adenocarcinoma. I was diagnosed with malignant nodules in both lungs, which is an automatic stage IV; it's not too distant an organ, but had to have entered my lymph or blood system to get there, so that's considered a metastasis.
Cindy
Reply # - August 6, 2017, 11:15 AM
Ok,
Ok,
Thanks for all of your input Cindy. I will take your advice and push for finding out what this is. I wish you the best of luck.
-Riley
Reply # - August 6, 2017, 01:05 PM
Riley,
Riley,
It sounds like you've already found the definition of tree in bud effect. My first thought was the same as Cindy, radiologist often make up and use their own terms that aren't used by others but this one is something that seems to have a set definition.
"The tree-in-bud sign is a nonspecific imaging finding that implies impaction within bronchioles, the smallest airway passages in the lung. The differential for this finding includes malignant and inflammatory etiologies, either infectious or sterile. This includes fungal infections, mycobacterial infections such as tuberculosis or mycobacterium avium intracellulare, bronchopneumonia, chronic aspiration pneumonia, cystic fibrosis or cellular impaction from bronchovascular spread of malignancy, as can occur with breast cancer, leukemia or lymphoma.[2] It also includes lung manifestations of autoimmune diseases such as Sjogren's syndrome or rheumatoid arthritis.[3][4]" https://en.wikipedia.org/wiki/Tree-in-bud_sign
The wait and see approach is used because if pulmonologists and general practitioners biopsied every nodule found (25% of all chest scans find nodules in the lungs) that probably isn't cancer would cause more harm than benefit. Lung biopsies aren't without their risks, in fact according to a study of pneumothorax is considered "common". Waiting for 3 months hasn't been shown to put people at risk for worse outcomes.
I don't know anything about effects or treatment of tree in bud effect. I would definitely want to get more information about what that means for you. I hope you get answers from the pulmonologist.
All best,
Janine