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Lumps, Bumps, Spots, and ShadowsSolitary Pulmonary Nodule: The Scary World of the Solitary Pulmonary Nodule

Gerard A. Silvestri, MD
Author and Funding Information

From the Medical University of South Carolina.

Correspondence to: Gerard A. Silvestri, MD, Medical University of South Carolina, 171 Ashley Ave, Rm 812-CSB, Charleston, SC 29425; e-mail: silvestr@musc.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(3):592-594. doi:10.1378/chest.13-0058
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About a decade ago I received a call from a colleague that I will not soon forget. As background, we had “grown up” in the university together, she an ICU nurse and I a pulmonary attending. She was a grizzled hospital veteran and was knowledgeable about all aspects of clinical care. She had worked her way up into management, and I had not seen her for a while when I received the call. She sounded panicked and asked if she could come by my office to review her medical record with me. When we met, she told me she had recently discovered a breast lump. After mammography and ultrasonography, she had her initial appointment with a surgical oncologist. The surgeon, a trusted colleague, had a reputation for having a good bedside manner. I asked her what he said, and her reply was “After he told me it might be a breast cancer, I completely shut down. I don’t remember a thing for the rest of the visit, and I was too embarrassed to ask.” After a good cry, we reviewed her chart, and I was able to reassure her that his interpretation was that the risk of cancer was <10% and that he believed this was likely a fluid-filled cyst in a patient with preexisting fibrocystic breast disease. He wanted a biopsy to rule out the possibility of cancer, but it was low on his list of possible differential diagnoses. I encouraged her to call him to confirm this prior to the biopsy to help alleviate her fears. All turned out well for this patient, but it left me quite unsettled. If this health care-savvy nurse heard something different (or in this case nothing at all) from what a competent, compassionate physician had told her, then what were my patients hearing when I discussed a newly discovered pulmonary nodule that may or may not be cancer?

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