CT scan and bronchoscopy? Can tumour remain occult after those?

Tue, 03/10/2020 - 11:27


Following an episode of haemoptysis I had a CT with contrast that showed no significant abnormalities ( 2 lower lobe lymph nodes there since 2013 on previous scan)

I met with the consultant this week for the first time and persuaded them to follow up with a bronchoscopy as I believe this is protocol but they did not offer it initially.

Firstly, can anyone offer insight into how often a lung tumour may be missed on a CT and also, if bronchoscopy is clear, is there anything else that can be done or should those 2 be enough to rule out a lung cancer?

As mentioned in a post relating to a Pancoast tumour , I have severe pain in the back of my shoulder which hurts at night especially. I have not had a bone scan or CTPET because I have no diagnosis.

I am unsure what I should push for to be sure the pain is not metastases from a tumour they can't find

I've had bloods and a spine x-ray which I am waiting for result from

Many thanks

Many thanks

JanineT Forum …

Hi Andrea,


I'm really sorry you're still having pain in your back and don't know why.  Lung cancer that causes pain and hemoptysis would be large enough not to be missed on a CT.   A pancoast tumor that causes pain in the shoulder and arm is located on the periphery of the lung so a bronchoscopy wouldn't be expected to pick up cells from a pancoast tumor because a bronchoscopy examines the tracheal and bronchial inside the lungs.  The CT scan is the gold standard for detecting nodules that might be lung cancer.  I wish we could be of more help.


I hope you and your care team can figure this out.



Dear Andrea,

I have been dealing exactly with the same medical dilemma as you are. 

I have had 2 chest X-rays, one HRCT scan and a pulmonary angiogram CT two months later...Results = All clear!

Still, I do have wheezing cough, strong pain in one side (left) irradiating to the shoulder blade and armpit and...of course blood-streaked sputum. It is getting worse and apparently I have nothing. I have been told 100 times what it CANNOT be, but I read from other posts and scientific works that endobronchial tumors (along the lining of the bronchus) can be missed and can still cause symptoms despite being in the millimiter range. Cough stimulus and shortness of breath can be triggered with small lesions, it depends on the abundance of cough-reflex surface receptors located in the bronchial linings in a defined region. 

I agree that the majority here thinks that it is unlikely, but it is not always black or white, sometimes it is grey.

I hope they don't find anything tomorrow, but will not let it go if everything is clear. Maybe autofluorescence bronchoscopy could find an occult (still symptomatic) lesion.


Good luck. Alex

JanineT Forum …

Hi Alex, 


I'm sorry you're having symptoms for which you can't find a diagnosis.  It's not just our opinion that it's unlikely that CTs miss lesions in the lung, it's the data from years of ongoing studies that show a chest CT will pick up lung abnormalities just a couple of mm wide.  As long as the radiologist sees and assesses something as notable it would be on the report.  This site focuses on oncology the care and management of diagnosed cancers.  Lung cancer is typically diagnosed by general physicians and pulmonologists.   You might talk to your pulmonologist about the possibility of and diagnostic procedures for an endobronchial lesion. 


I hope you find a way to mitigate your symptoms.

All best,



HI Janine,

thank you for your comments and advice. I do understand that the site is more focussed on the care and management for those with a diagnosis. Just wanted to point out that lung cancer is unpredictable and, despite rarely, can present in subtle manners that can escape from the doctor's radar.

Even with the most advanced diagnostic tools available, factors such as the central location of the tumor or observer error can end up in missing a tumor. It has happened in the past. The goal of my post is to warn people that if lung cancer high-risk symptoms persist (i.e. blood in sputum, dry cough and chest pain, in addition to less specific ones) the the lung cancer hypothesis should not be totally dismissed. 

I hope that Andrea as many others worried to have LC (including myself) will prove me wrong and something else is causing the symptoms!

Again, thank you Janine for the support and your reply.