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Answer to your Health Question

Question (09/21/2012):

Title: Pulmonary nodule in middle lobe | Focal pulmonary thickening around the same lobe | Patchy ground-glass opacities.

I have a 7.0 mm pulmonary nodule in my middle lobe of my right.

There is also focal pulmonary thickening around the same lobe.

There are patchy ground-glass opacities bilaterally.

My pulmonary function test revealed chronic respiratory acidosis with moderate hypoxemia.

And 2 days after abdominal surgery I developed a lower lobe pleural effusion as well as costogenic angle structures.

Can you tell me what all of this means and list some possible causes.

My neurologist is considering sarcoidosis.

Could this being accurate?

Answer:

Thank you very much for your question.

A solitary pulmonary nodule is a round or oval spot (lesion) in the lungs that is seen with a chest x-ray or CT scan.

More than half of all solitary pulmonary nodules are noncancerous (benign). Benign nodules have many causes, including old scars and infections.

Infectious granulomas (reactions to a past infection) cause most benign lesions.

A pleural effusion is a buildup of fluid between the layers of tissue that line the lungs and chest cavity.

Two different types of effusions can develop:

-Transudative pleural effusions are caused by fluid leaking into the pleural space. This is caused by increased pressure in, or low protein content in, the blood vessels. Congestive heart failure is the most common cause.

-Exudative effusions are caused by blocked blood vessels, inflammation, lung injury, and drug reactions.

Pulmonary sarcoidosis may manifest with various radiologic patterns: Bilateral hilar lymph node enlargement is the most common finding, followed by interstitial lung disease.

At high-resolution CT, the most typical findings of pulmonary involvement are micronodules with a perilymphatic distribution, fibrotic changes, and bilateral perihilar opacities.

Sarcoid granulomas frequently cause nodular or irregular thickening of the peribronchovascular interstitium.

A solitary lung mass or nodule is rarely seen in sarcoidosis; however, individual granulomas that coalesce may produce the appearance of solitary masslike opacities .

In some clinical contexts, multiple well-defined rounded macronodules (nodules with diameters exceeding
5 mm) might mimic a metastatic process.

Patchy ground-glass opacities are seen in an estimated 40% of patients with parenchymal changes due to pulmonary sarcoidosis; extensive ground-glass opacities are much less common.

The patchy ground-glass opacities in sarcoidosis are always accompanied by other abnormalities and often are superimposed on a background of interstitial nodules.

When the presence of pulmonary sarcoidosis is suspected, diagnostic procedures should ideally allow
(a) histologic verification,
(b) assessment of the extent and severity of organ involvement,
(c) assessment of whether disease is stable or likely to progress, and
(d) determination of whether a patient might benefit from treatment.


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