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Interpreting CT of chest with contrast

Forums General Melanoma Community Interpreting CT of chest with contrast

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      Wouldn't you know we would get the radiology report on the Saturday before a holiday! We will have to wait until Tuesday to talk to anyone, and it will have to be a Nurse Practitioner as the oncologist is away at a conference. Arghhh! To give a little background, hubs was diagnosed with nevoid malignant melanoma in 2015, did a year of interferon treatment, and in January 2107 was diagnosed with metastatic cancer after a PET SCAN lit up parotid gland and very small spot on left lung. he's had 3 out of 4 combo treatments (Opdivo and Yervoy) and is scheduled to get the 4th one on Wednesday. He was treated twice for pneumonia and Monday the pulmonary specialist decided to do a CT with contrast and a CT without contrast as well as bronchoscopy. The pulmonary specialist said everything was "fine" but the report that we got in the mail today is concerning. 

      FINDINGS: There is a 12.5mm nodule within the superior segment of the left lower lobe. This appears increased in size from comparison exam. This is noncalcified in a somewhat spiculated margin may represent a pulmonary neoplasm. There is a small left pleural effusion. 

      Cardiomegaly: Pulmonary vascular congestion with evidence if interstitial alveolar edema. Prior granulomatous disease. Limited imaging of the upper abdomen shows a small hiatal hernia. 

      A small mediastinal and hilar lymph nodes. These are non-specific. Or degenerative changes of the spine. 

      Impression: Enlarging nodule with the superior segment of the left lower lobe. This may represent pulmonary neoplasm. Followup PET CT is recommended after the patient has pulmonary edema has been corrrected. 

      To me, that sounds like that tiny spot in lower left lung may not be so tiny anymore. The area around his parotid gland on right side of jaw line extending behind ear enlarged and became hard and painful after initial Opdivo&Yervoy Infusion. It began to press on a facial nerve and caused a few days of intense pain. But then after about 4 days, it began to shrink and has shrunk consistently. Hubs say he can't even feel the initial little pea size lump anymore. It doesn't really make sense to me that one spot would seemingly respond so well, while another grows larger. Any thoughts? I thought if one spot responded, all would, since it's all melanoma, but what has your experience been? Tuesday seems like a very long time from now…..

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          1.2 cm is not large for a lung mass — there are many causes of this sort of mass. Also, if its early in your treatment, the small growth in size may represent pseudoprogression. For now don't worry too much — traditionally a lung nodule would have to be more than 2cm to be suspicious; theyre just giving it extra scrutiny because you have metastatic disease elsewhere. 


            Hi Allison,

            Sorry for your worries.

            1.  Unfortunately one can have heterogenous reactions to therapy…meaning with some melanoma lesions responding and others not.

            2.  I do think a growing lesion on sequential scans is concerning….no matter size.

            3.  However, the first scan was a PET and this was a CT…different type scans can "see" things a little differently…so comparison of the same sort of scan one to the other is more valuable.

            4.  Why did the pulmonologist who did the bronch not do a biopsy of this lesion?  (Though if the location is too far out in tissue it is not possible.)

            5.  Hopefully, and certainly this is a real possibility, you are dealing with pseudoprogression.  Pseudoprogression is exactly what your husband experienced with the lesion at his parotid.  It became swollen (and even painful) because it enlarged with the inflitrating t cells and surrounding inflammation that produces, before it went away!  This can happen with more internal lesions as well, though frequently with less pain, depending on what nerves they are (or are not) pressing on.

            Hopefully the lesion in question will disappear with subsequent treatments!!!  Talk to your doc.  I suspect that they will carry on and rescan (preferably with a repeat CT) in a bit – and that sounds like a good plan to me.  Hang in there.  celeste

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