Lungs: Anterior left upper lobe masslike consolidation measures 6.5 x 3.8 cm with adjacent parenchymal stranding. Additional focal groundglass opacity in left upper lobe measures 7 mm, series 4-51. Several scattered groundglass nodules seen in the right lung ranging from 4 to 5 mm, with a representative nodule in series 4-99. No sizable pleural effusions.
TECHNIQUE: CT was performed from lung apex to the lung base on the multislice CT scanner without the use of intravenous contrast. Sagittal and coronal reformatted images were performed. Coronal MIP images were performed.
The total DLP was 280 mGy-cm and the CTDI was 8 mGy. Low dose protocols were performed.
One or more of the following dose reduction techniques were used: automated exposure control, adjustment of the mA and/or kV according to patient size, use of iterative reconstruction technique. A total of 0 CT (Computed Tomography) examinations and 0 myocardial perfusion studies have been performed on this patient over the past 12 months. Counts as indicated include examinations performed within our network.
COMPARISON: 4/29/2022
FINDINGS:
Visualized Inferior Neck: Visualized inferior neck soft tissue structures are unremarkable. Visualized thyroid gland is unremarkable.
Vasculature: Prominent ascending aorta measures 4.1 cm in diameter. Main pulmonary trunk is within normal limits.
Aortic Atherosclerosis: Present Coronary vascular calcification: Mild Assigned values based on visual inspection. Consider calcium score CT for objective measurements and risk stratification.
Mediastinum: Heart size within normal limits. No pericardial effusion. Airway is patent. Esophagus is unremarkable.
Lymphadenopathy: Prominent mediastinal lymph nodes some which are partially calcified. Prominent subcarinal node measures up to 10 mm in short axis.
Chest Wall: Chest wall soft tissues are unremarkable. Degenerative changes of thoracic spine noted. No aggressive destructive osseous lesions. Ribs are intact.
Visualized Abdomen: Unremarkable
Lungs: Anterior left upper lobe masslike consolidation measures 6.5 x 3.8 cm with adjacent parenchymal stranding. Additional focal groundglass opacity in left upper lobe measures 7 mm, series 4-51. Several scattered groundglass nodules seen in the right lung ranging from 4 to 5 mm, with a representative nodule in series 4-99. No sizable pleural effusions.
IMPRESSION: 1. Masslike consolidation left upper lobe, new since prior exam. Correlate with PET/CT for further evaluation.
母亲76，大约一年前开始抱怨体力下降了老了。 除了偶尔左上后背疼也没有其他症状。去年底回国做了非常详细的体检，包括CT，也没发现什么，包括多年的小于1厘米的肺结节也没有变化。
最近由于填一个活动申请表需要chest x-Ray，x-ray发现左上肺有白色阴影，PCP把她转给肺专科。她没有任何症状，也没有任何的不适。医生又开了CT。仅仅半年后CT显示左肺，大约心脏上方的位置有肿瘤，尺寸 6.5x3.8cm。 下一步准备做支气管镜。报告具体内容如下：
Lungs: Anterior left upper lobe masslike consolidation measures 6.5 x 3.8 cm with adjacent parenchymal stranding. Additional focal groundglass opacity in left upper lobe measures 7 mm, series 4-51. Several scattered groundglass nodules seen in the right lung ranging from 4 to 5 mm, with a representative nodule in series 4-99. No sizable pleural effusions.
医生描述肿瘤是solid，说明密度很大，半年间出现这个尺寸说明长得很快。虽然还不知道结果如何，我的内心极度凌乱，感觉非常糟糕。请大家帮忙看看，分享一下有关下一步治疗的经验和知识。希望可以少走弯路，得到及时快速的治疗。
非常感谢，鞠躬为敬！
肿瘤从第五行后边几个图开始出现
为什么这么说，因为快速发展的恶性肿瘤，周围组织抢了营养，而中心部分抢不到，就会岀现坏死，从而造成中心部位密度与周围不同
可能与左上肺肿物有延续性（部分）。这个在胸骨/胸锁关节与几个大血管之间的影像向右延伸，好像累及右肺上叶，突入肺组织内导致右上肺壁层胸膜边缘不完整（上面的第二张照片）。
有没有半年前同一个位置的CT照片？
EXAM: CT CHEST WITHOUT CONTRAST
HISTORY: Lung Nodules
TECHNIQUE: CT was performed from lung apex to the lung base on the multislice CT scanner without the use of intravenous contrast. Sagittal and coronal reformatted images were performed. Coronal MIP images were performed.
The total DLP was 280 mGy-cm and the CTDI was 8 mGy. Low dose protocols were performed.
One or more of the following dose reduction techniques were used: automated exposure control, adjustment of the mA and/or kV according to patient size, use of iterative reconstruction technique. A total of 0 CT (Computed Tomography) examinations and 0 myocardial perfusion studies have been performed on this patient over the past 12 months. Counts as indicated include examinations performed within our network.
COMPARISON: 4/29/2022
FINDINGS:
Visualized Inferior Neck: Visualized inferior neck soft tissue structures are unremarkable. Visualized thyroid gland is unremarkable.
Vasculature: Prominent ascending aorta measures 4.1 cm in diameter. Main pulmonary trunk is within normal limits.
Aortic Atherosclerosis: Present
Coronary vascular calcification: Mild
Assigned values based on visual inspection. Consider calcium score CT for objective measurements and risk stratification.
Mediastinum: Heart size within normal limits. No pericardial effusion. Airway is patent. Esophagus is unremarkable.
Lymphadenopathy: Prominent mediastinal lymph nodes some which are partially calcified. Prominent subcarinal node measures up to 10 mm in short axis.
Chest Wall: Chest wall soft tissues are unremarkable. Degenerative changes of thoracic spine noted. No aggressive destructive osseous lesions. Ribs are intact.
Visualized Abdomen: Unremarkable
Lungs: Anterior left upper lobe masslike consolidation measures 6.5 x 3.8 cm with adjacent parenchymal stranding. Additional focal groundglass opacity in left upper lobe measures 7 mm, series 4-51. Several scattered groundglass nodules seen in the right lung ranging from 4 to 5 mm, with a representative nodule in series 4-99. No sizable pleural effusions.
IMPRESSION:
1. Masslike consolidation left upper lobe, new since prior exam. Correlate with PET/CT for further evaluation.
HCC/RAF: Yes
提前联系相关的治疗需求，信息充分不是坏事
只有尽快活检。建议还是在美国做吧
但没有看到对右肺上叶外缘的结节的具体描述。个人感觉这个病变可能不是来自肺实质，而且不能排除是来自壁层胸膜或纵隔。
应该尽快做支气管镜，取活检明确诊断。现在的支气管镜检查可以在支气管镜内装置的超声波探头引导下（EBUS），通过穿刺进行活检。这要比在CT引导下的经皮肤穿刺活检更加有效，也更加安全。
治疗方案以及能不能手术，首先取决于活检的病理诊断报告，有的肺肿瘤是不能采用手术治疗的（比如某些来自胸膜的恶性间皮瘤）。其次取决于肿物的临床表现，比如与周围组织器官的关系。仅据上面看到的信息，这个病例应该已经不是早期（应该至少是T3N3），能不能手术要看具体情况，这需要和医生探讨。
建议下次见医生时，特别是做支气管镜检查前，一定要给医生看我画红圈的那张CT影像，询问能不能排除恶性病变。
“占位”，癌变的可能性很大。我爸爸不吸烟，身体没有任何不适，一切健康。医生建议穿刺，但老人家慎重考虑后决定不穿刺，直接做微创手术拿掉。上海中山医院袁云峰医生做的手术。手术比预计的多了一倍时间，发现癌变已转移。手术挺成功，但因为有转移，手术康复后做了好几次化疗，还是受了不少苦。
去年底发现肺癌又回来了，老人家决定不再手术。幸好有突变点，他从今年2月开始吃靶向药，效果还可以，能保持不错的生活质量。医生说要吃2年。
我跟家里人打好预防针，
一是必须如实告诉我病情，由我自己决定治疗不治疗，怎么治疗，别人不可以给我做决定
二是根据严重程度，放化疗要遭的罪，和生活质量综合考虑，有时候放弃治疗反而是最优选。
三是不仅要考虑到病人的存活问题，还要考虑对家里其他人造成的时间负担和经济负担，几个月忍一忍就过去了，七八年就没必要了。
我上面只有经历过好多次可能才会看开，第一次的话大多数人还是会选择强求。
我母亲八年前因为肺积水，一查发现肺部有2x2厘米的肿块，周围呈毛玻璃状，淋巴腺肿大，甲胎蛋白指标非常高，医生认为已经发展到三期，大约还剩三四个月的时间。做了基因测序但没有发现有突变，我母亲心脏有两个支架不敢手术，试着用了一下紫杉醇，白血球掉得厉害，身体变得很虚弱，我们决定不再用了。后来查到加拿大的一个文献，说蒲公英根对癌症有效，我们就试着用了，又配合美国生产的蘑菇粉，现在控制得很好，各种指标都正常了，肿块已钙化了，以前半年一次CT检查，现在一年查一次。最近我同学的母亲胰腺癌，合并肝和骨转移，梅奥中心做了基因测试，看是否有对应的靶向药，正在等结果。同时医生建议同学寻求临终关怀服务，我把我母亲的方法推荐给他，他的反馈是，用药一个星期后，感觉他母亲可以比较长的时间和他谈话了，我们正在观察。
舍妹夫刚在今年的元宵节因肺癌去世，发现时觉得后背疼痛异常，再三劝告后入院检查是肺癌，病灶在左肺，而且转移到右肺。医生觉得手术已经晚了，故采用化疗，但4个半月后，他走完人生道路。如你母亲的肺只有一叶有问题，我个人认为应该毫不犹豫手术处理，越快越好。过后按照医生建议跟踪检查，每三个月一次。总之，发现的早现在不论是在美国还是在中国，治疗肺不是大事！
蒲公英根粉里有沙子，从胶囊中倒入凉开水或温开水中搅拌后，喝掉悬浊液，沉在杯底的沙子倒掉，千万不要用热开水，会破坏药效。瓶子上让一天吃三粒，我让我母亲早晚空腹各三粒的量，没发现问题。蘑菇粉早晚空腹各一粒。希望对你有帮助
我母亲在中国，食用油只用传统压榨工艺生产的花生油，其他植物油理论上有不少好处，但是通常是用萃取法生产的，像豆油、玉米油等，这样生产的油中肯定有萃取剂残留，而萃取剂是有毒的。另外坚决杜绝味精和鸡精，尽量少吃餐馆，感觉至少美国的中餐馆离开味精就不会做饭。如果吃面食，一定用有机的，因为小麦不怕除草剂，所以小麦种植肯定用除草剂，除非是有机的，那么小麦中就会有除草剂残留。老人们消化吸收能力差，鸡蛋吸收容易，多吃鸡蛋，以及新鲜的蔬菜和水果。我后院有果树，知道离开农药果子都是虫子，所以水果尽管削皮吃。不能削皮的水果不吃
他认为维生素B2和叶酸对癌症有辅助疗效，我知道后也让我母亲使用