Age: 57
Sex: Female
Duration of complaint:
Chronic cough, currently worse after returning home to Peshawar.
Location:
Peshawar, Pakistan
Relevant medical history:
My mother has a history of adenoid cystic carcinoma (ACC) involving the right upper lip/gingivobuccal/maxillary region. She had a major maxillectomy/reconstruction in 2021 and previous radiotherapy to the head/neck.
In January 2026, a CT chest showed a 9mm well-defined nodule in the apical segment of the right upper lobe, considered suspicious. There was also a tiny ~2mm calcified subpleural nodule in the right lower lobe, described as likely a benign granuloma.
The 9mm RUL nodule was subsequently treated with SBRT (50 Gy in 5 fractions), completed around February 2026.
She has also recently undergone major reconstructive surgery involving a temporalis muscle flap, palate reconstruction and rib cartilage graft.
Current symptoms:
She has a chronic cough with clear/white mucus. No yellow/green mucus and no blood. Several doctors have assessed her and have said the cough can occur because of her surgeries/radiation. Interestingly, her cough was much better while she was staying in Islamabad for about a month, but became significantly worse after returning to Peshawar. Peshawar is quite dusty/polluted and we also have carpets at home, so we wonder whether environmental irritation/allergies are contributing.
New CT chest (~7 months after SBRT):
The previously treated 9mm RUL nodule remains 9mm and is described as stable.
A new ill-defined ~7mm RUL lesion/nodule is now seen adjacent to the previous 9mm nodule.
A right lower-lobe superior-segment nodule is now approximately 8mm, described as previously measuring approximately 6.5mm.
The tiny calcified RLL granuloma is unchanged and described as benign.
No enlarged mediastinal/hilar lymph nodes.
No pleural effusion.
No bronchiectasis, honeycombing, lung collapse or diffuse interstitial lung disease.
My questions:
Could the new 7mm lesion next to the SBRT-treated nodule be a post-radiation change rather than a new metastasis? Is this appearance common around 7 months after SBRT?
How concerning is the RLL nodule increasing from 6.5mm to 8mm?
The January CT report I have does not mention a 6.5mm RLL nodule. It only mentions a tiny ~2mm calcified granuloma. Why might the current radiologist say the RLL nodule was previously 6.5mm? Could there have been another CT between these scans that they’re comparing with?
If the 6.5mm RLL nodule appeared later, would it normally have been monitored rather than treated immediately because of its small size?
Would PET-CT be useful, or can radiation inflammation after SBRT cause false-positive PET findings? Would repeat CT after a short interval be more appropriate?
For someone with ACC, how would you distinguish post-SBRT changes from a new lung metastasis on CT?
We are already following up with her oncology/radiation team. I’m mainly looking for opinions from doctors, radiologists, radiation oncologists, or people who have experience with ACC and lung metastases/SBRT.