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Doctors Lounge - Chest Answers
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| rangar
- Thu Apr 16, 2009 1:40 am |
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A Current diagnosis
I have done a Chest X ray followed by a CT Scan
Lymphnodes are enlarged and the conclusion from CT Scan is that it is Mediastinal Lymphodenopathy
I have also done ACE test and the reading is 47 mg/IUL
I have no symptoms of pain , coughing, weight loss ; though I get tired nowadays may be more I am not walking regularly and not fit
B Other parameters
Iam 54 yrs old male - height 5' 10" ,weight - 88 kgs
I am a hypertensive – take daily 2 Aten 25 tablets and 1 Telma 40
I took a MRI in oct 2007 – showed lacunar infract --take Clopilet 75 mg
My cholestrol levels have been high --My Triglyceride levels are elevated -above 250 – I take Storvas EZ
My Uric acid is at 8 ,Urea at 40 and S.Creatinine at 1.7 - have been asked to control this
C Suggested course by Chest physicians ; for A above
1 Some specialists advise that I should do a CT guided biopsy –
Radiologist had advised that Contrast had to be used to be able to locate the node tissue , which in my case is not advisable due to creatinine levels.
Therefore Chest physicians advise that success not guaranteed as the lymphnodes in lungs may not be located easily –( they could , if possible locate a node in the neck )
Another option is to do a Tru cut biopsy through a Posterior approach on Lymphnodes in lungs
2 Another opinion is that we leave it as it is and do a scan after 3 months ( Chest X Ray one year back also showed some opacity and since there are no symptoms , may be there is no major cause for worry )
3 Do a PET CT scan
D Questions /advice
What would you suggest as the course of action ?
What could be the underlying disease ( TB, Infection, Lymphoma , Sarcoidosis )
Appreciate your medical advice
Thanks
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| John Kenyon, CNA
- Sun Apr 26, 2009 8:03 pm |
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 Hello --
Thank you for your comprehensive report. This is helpful.
Going from last to first on your list, the answer to (D) would be that it could be any of the possible conditions you mention, but since it seems inactive or very slow growing now (depending on what it actually is), the CT-guided biopsy would be ideal. Depending on where you are, there are some very skilled and anatomy-wise doctors who can do this without contrast if necessary, although there are also some alternatives, which have been offered you. It should be biopsied sooner than later, on the off chance it is malignant, since it would seem to be timed very well to be manageable if it is. Of course it could be any of the other things listed too, and statistically the odds of it being one ove the others means very little as far as predictions. Otherwise you wouldn't need a biopsy done. Basically TB and sarcoid are less likely but entirely possible. Infection and malignancy are about equally likely ahead of those other two. Calcification is also a possibility.
I hope this is helpful to you. Please follow up with us here as needed. Best of luck to you.
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