Can a small lesion in lungs cause back pain and discomfort?

Question

Hi doctor,

I am 50 years old male. I have middle back pain for the past eight years. It is usually in the middle right back between the shoulder blades. I have this pain when I stand for an extended period. Recently, I felt the pain radiating from my back into my chest. I think that I have a knot between my shoulder blades. It seems to get worse as the day progresses with stress and anxiety. After a recent treadmill run, I noticed a knot like a pain in my upper right back. It is accompanied by an urge to cough. Other new symptoms include throat clearing and occasional breathlessness on humid days.

But all the pain gets relieved with rest and sleep. But it is worse throughout the day. My recent blood report showed WBC with 3800 per microliter, RBC with 5.06 million mcL, my hemoglobin is 154 g/dL, hematocrit showing 45 %, platelets with 145,000 platelets per microliter of blood. My EKG, echocardiogram, stress test and abdominal ultrasound were all normal. Ultrasound showed a fatty liver.

My doctor advised me to do a chest X-ray. They found a small lesion on my left lung at the rib one area. He said it is nothing and recommended for a CT scan. I am living with full of anxiety. I read somewhere that 60 percent of lesions in men are cancer. Surely, I am not asking for a diagnosis. Can a small lesion have such ability to cause so much pain and discomfort? Is it possible to have advanced lung cancer? But my lungs look clear on the rest of the X-ray image. Is there anything else in the blood work or any other tests showing the possibility of cancer? I have no cough, wheezing, fever, loss of appetite, weight loss, and unexplained sweats.

Answer 1

Hi,

Welcome to icliniq.com.

I have gone through the attachment (attachment removed to protect patient identity). Your symptoms are not suggestive of cancer. It is a spinal cause which is causing the symptoms (spondylosis). The points which favor for the spinal cause is the long duration of symptoms, your sitting job, worsening as the day progresses, knot-like feeling and radiation to the chest (due to nerve compression).

Malignancy will not stay for an extended period without causing any symptoms, and prolonged survival is not possible. With the absence of symptoms, it is too premature to consider it as malignancy. Usually, most of the lesions found incidentally on the chest X-ray are benign as they may indicate a fibrotic lesion of the old healed infection either clinical or subclinical. Also, your doctor has already seen it, and it reduces the chances of having a malignancy in you as they will have some features. So overall, the possibilities for malignancy are very less, and these symptoms are not correlating to it.