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Forum Name: Gastroenterology Topics

Question: Swollen spleen and enlarged lymph nodes in neck


 Summer07 - Mon Jul 23, 2007 2:25 pm

I am a 33 yr old female searching for some answers or direction. I have a BAD pain in my left side just under/behind my ribs. I also have several enlarged lymph nodes in my neck (one is REALLY large) none with pain. I have been dealing with my family doctor on the abdominal pain since February, the swollen lymph nodes just came on with in the last few weeks. Blood work shows that I don't have mono. In March I had a ct scan which came back normal with the exception of "multiple lesions on the liver ranging in size from 4cm to 12 cm" but nothing to explain the pain I have on my left side. I went back to the doctor 3 weeks ago because I am worn out, my hair is falling out like crazy, I am weak and I just falt out have no energy. He told me to stop coloring my hair and get some rest! He did say it feels like my spleen is enlarged and sensitive but dismissed it since the blood work showed no mono. I am certain there is something wrong. The pain keeps me from sleeping and doesn't even go away with Aleve!!! Where do I go from here and what should I ask to have tested or done.
 Dr. Chan Lowe - Wed Jul 25, 2007 4:39 pm

User avatar Hi Summer07,

There are many possibilities for your symptoms. With the mono test negative it makes Ebstein Barr Virus (EBV) much less likely. Another virus called cytomegalovirus (CMV), a cousin of EBV, can cause identical symptoms.

Unfortunately, I also have to add that this could be cancer. With spots in the liver, swollen/painless lymph nodes and your other symptoms this really should be considered.

I would recommend that you also have your thyroid levels tested. You may also need some further imaging studies, such as an abdominal CT scan, to help get a better sense of what is going on in the liver.

If you are not able to find any answers you may need to have a biopsy done of the lymph node or possibly the spots in the liver to help figure out what they are.

Follow up with your doctor is important.

Best wishes.
 Summer07 - Thu Jul 26, 2007 5:00 pm

My doctors office called me this morning to come in and discuss the results. They were as follows:
Liver-of normal size. There were several small, scattered low attenuation lesions throughout the right and left lobes. The largest measuring 8 mm. The density appeared to be a simple cyst but that determination could not be made with certainty.
Spleen was of normal size with a indeterminate, low attenuation lession approximately 7mm in size. They were uncertain as to whether this was a cyst or solid lesion.
The doctor requested to have further test done starting with a hepatic and splenic ultrasound right away. The nurse said don't worry it's probably nothing.
I still have the pain in my side and my lymph nodes are still swollen with one or two NEW smaller swollen lymph nodes in the neck as well.
So could you please help me understand what this all means? I was trying my hardest not to start crying in the doctors office so I swollowed the lump in my throat and didn't ask any questions. It seems that there might be a concern of lymphnoma correct? What really scared me was the nurse ask if I wanted to have these test done here at the local hospital or in a city which about an hour from here. It kind of made me think this was serious. What other tests should I consider if any?
THANK YOU SO MUCH!
 Dr. Chan Lowe - Mon Jul 30, 2007 10:51 pm

User avatar Hi, I'm not exactly certain what is causing this. I wish I could tell you that this is not cancer but it may be. Lymphoma is possible.

Getting the further imaging will be helpful. If there is still a question I would recommend a biopsy of one of the areas be done. This can often be done by using a small needle guided by a CT scan to get a small piece of one of the areas for analysis. This will usually give a definite answer to the cancer question.

My best advise for you is to not get 100% fixed on the idea that this is cancer. (It's easy to say but hard to do.) Try to keep busy until you get more results. It'll help keep your mind off it. Keep in close contact with your doctor. I wish you the best.

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