Q: I have been wheezing for over a year now. I got sick and went to the doctor because I had a pain in my chest that hurt clear through to my back. The doctor did an X-ray and found a spot on the medial part of my left lung. The spot wasn’t there in 2008 when I had an X-ray. I’ve since had a CT scan, PET scan and none of the doctors including a pulmonologist knows what the spot is. It was found in November 2010.
I took two rounds of antibiotics and it’s still there so I need to know what to do. I have shortness of breath, wheezing and a dry cough.
A: Lung nodules can generally be seen on X-ray or CT (computed tomography) scan. The lesion you have is more likely to be benign (non-cancerous) if you are under 40, if it is small, if you are a non-smoker, and if there is calcium in the nodule. Benign nodules and tumors don’t ordinarily cause symptoms; however they can and if so, present with shortness of breath, wheezing, and a never-ending cough. They may be the result of a lung abscess, an infectious fungus, tuberculosis or round pneumonia. Some of the more common types of benign lung nodules are bronchial adenomas, hamartomas and rare neoplasms. Bronchial adenomas comprise about 50% of all benign lung nodules. They are tumors from mucous glands and ducts of the large airways of the lungs. Hamartomas, the most common type of benign lung nodule is made up of tissue from the lining of the lung, as well as fat and cartilage and is usually located in the periphery of the lung. Lastly, rare neoplasms such as lipomas which are benign are comprised of fatty or connective tissue.
Suspicious nodules may require a biopsy or even removal of an entire nodule if an individual is a smoker and if the lesion is larger than when previously seen. While your physicians may not be able to identify the nodule, they may, to a degree, be guided by the size of the nodule. If it remains the same size for at least two years, has smoother edges and is even in color, it is generally considered benign, while cancerous nodules tend to double in size every four months.
I recommend you take your CT, PET scan, X-rays and office notes to a new pulmonologist for a second opinion. Be sure to take a list of your medications because some drugs can cause what is known as an ACE (angiotensin converting enzyme) inhibitor cough, although you are also wheezing and ACE inhibitor coughs generally aren’t accompanied by wheezing. Despite this, it would be a shame if your problems were all drug-related and could have been modified when your symptoms first began. In any event, I’m sure your primary care physician and specialist(s) will not take offense, particularly if neither has any idea of what the spot represents and this weighs so heavily on your mind. He or she will be able to review the records and films in order to determine if new studies are appropriate. What concerns me is your wheeze which requires investigation, although your two years of stability is reassuring. In summary, you have symptoms that need to be addressed, so don’t wait any longer to seek care.
