Do you want to take medicine? Do you need surgery? Doctor's answer: A 58-year-old man developed a ground glass nodule in the lung four months after being tested positive

After becoming positive in December last year, 58 year old Li has been worried that his lungs will be affected. In January of this year, he underwent a CT scan and no abnormalities were found. The CT report of the physical examination in April made Old Li panic: a ground glass nodule was added to his lungs. Old Li thought about how the nodule had grown suddenly since the examination three months ago did not show it?

Feeling flustered, he quickly went to see Dr. Fan Junqiang, the chief physician of the Department of Thoracic Surgery at the Second Hospital of Zhejiang University. After carefully comparing Mr. Li's physical examination report, Director Fan found that this ground glass nodule had grown rapidly in a short period of time and was highly likely to be an inflammatory nodule.

Lao Li asked anxiously, "Doctor, do I need to do another examination to confirm?"

Director Fan comforted Old Li that the interval between going for the examination now is too short and has no reference value. At least three months should be left for the examination. Old Li asked again, "Do I need to take medicine?" Director Fan saw that Old Li had already fallen into a worried mood and said directly to him, "Don't take any medicine. It's useless even if you take it. Even if you don't take it, the nodules will disappear."

Many people like Lao Li found ground glass nodules suddenly growing in lung CT examinations. Others found that the ground glass nodules became larger after COVID-19 Yang or after three shots of vaccine. After sorting out the questions from patients in the "Zhejiang Medical Online Pulmonary Nodule Communication Group", it was found that the three most concerned questions about ground glass nodules are: Do you need surgery? Do you want to take medicine? How long will the follow-up be?

Regarding these doubts, Zhejiang Medical Online has specially invited Dr. Zhang Guofei, Deputy Chief Physician of the Department of Thoracic Surgery at Zhejiang University Second Hospital, and Dr. Zhu Fengjie, Chief Physician of the Department of Cardiothoracic Surgery at Zhejiang Provincial Hospital of Traditional Chinese Medicine, to answer and clarify the questions for the group. Below are some typical questions, hoping to be helpful to those who are also troubled.

Q: I am 60 years old, female. I have never found any nodules during my annual physical examination before. After three consecutive injections of COVID-19 vaccine, the physical examination of the previous year said that there were tiny nodules. Last year, the physical examination was 4 mm ground glass nodules. What is the relationship between the formation of this pulmonary nodule? Because the people around me also feel the same way, some nodules have grown larger, while those without nodules have.

Zhu Fengjie: I would like to ask if you have ever had a CT scan in your previous health check ups, because our previous health check ups were all chest X-rays, and CT scans have not yet become popular. Now everyone is paying more attention and starting to take CT scans, so there will be a lot of nodules detected. You have found that this nodule is 4mm, so there should be no need for special treatment. Regular follow-up is sufficient. Then, during the annual physical examination, check if the nodule has changed before deciding whether to treat it.

COVID-19 vaccine may have some effect on the production of pulmonary nodules. We also met some young people in the clinic. After getting the COVID-19 vaccine, we found nodules in the lungs. This nodule grows quickly, and many people are very nervous. It is indeed possible that the vaccine caused the proliferation of lung lymph nodes. Don't worry too much about the size of 4mm, it can be rechecked for about a year, and it is completely possible that it will gradually disappear.

Q: A 61 year old patient had lung CT results in January this year, showing local bronchiectasis with localized emphysema in the lower lobe of the left lung, chronic granulomatous lesions in the lower lobe of the left lung, and adhesions in both lower pleura. Similar to the 2021 film. In March of this year, I underwent a lung function test at Shao Hospital, and my lung function was generally normal. How should I treat it?

Zhu Fengjie: Bronchiectasia and semi emphysema mainly depend on whether you have symptoms. If there are no symptoms, it does not affect daily life. If there is no obvious cough, sputum, fever, chest tightness, or shortness of breath, there is no need to deal with it. There is no significant difference compared to previous films. It is recommended to have a CT scan every year. But if there are symptoms, such as frequent coughing, sputum production, fever, chest tightness, and shortness of breath, it is necessary to seek medical attention from the respiratory department of the hospital in a timely manner. Generally, internal medicine treatment is recommended first for bronchiectasis. If internal medicine is not effective, further treatment can be sought from our surgery department.

Question: Female, 28 years old, underwent a physical examination one month ago, and a round, faint, high-density shadow with a diameter of 13 millimeters was observed in the left upper lobe of the lung; Scattered small circular high-density shadows with clear edges can be seen in both lungs. What are the general reasons for the appearance of nodules? I have a regular lifestyle, do not smoke or drink alcohol, do not cough, and do not have any other symptoms. What is the general frequency of follow-up in the later stage, and how is it more appropriate to arrange a pregnancy preparation plan?

Zhu Fengjie: There are actually many reasons for the occurrence of nodules: they are closely related to air pollution, changes in the entire environment, including second-hand smoke, and some genetic factors. Like your nodule, which is 3mm in size and slightly larger, you can follow up for about six months to a year, and then check a CT scan for six months. It is possible that it will disappear by then. If you have a plan to prepare for pregnancy in the future, I think you can follow up for a year and have a CT scan every six months. If there are no stable changes after doing it twice, you can consider preparing for pregnancy. Because during the preparation period, one should not be exposed to radiation, and then wait until the child is born before going for a follow-up examination.

Question: Female, 30 years old, first diagnosed with ground glass nodules this year, multiple, with a maximum size of 5mm x 3mm located in the lower lobe of the right lung. May I ask if anti-inflammatory treatment is needed in the later stage? Is dynamic observation sufficient?

Zhang Guofei: According to your description, your largest nodule is actually only 5mm x 3mm. Currently, in clinical practice, nodules of this size can be dynamically observed. Nodules below 5 millimeters only need to be re examined once a year. If it's your first discovery, you can try taking anti-inflammatory drugs for a week.

Q: May I ask what clear medical reasons may lead to ground glass nodules? Is ablation technology mature now?

Zhang Guofei: At present, there are many medical reasons for ground glass nodules, which may be infectious diseases, such as pneumonia or lung manifestation. Some patients with early pneumonia may also develop ground glass nodules. There are also many methods for treating ground glass nodules, and the ablation technique you mentioned is indeed a relatively effective method. However, current ablation techniques are not suitable for all ground glass nodules, and one needs to choose their own treatment plan under the guidance of a doctor.