ct scan shows mediastinal and extensive hilar adenopathy

[anupam004]

Hi,

I am 34 yrs old. I got my normal medical done on 03jun08 which included chest x-ray, normal blood tests, urine tests etc. My LDL levels came closer to 165 and the chest x ray showed 'lymph node swelling' and the report suggested that CT scan is recommended.

On 23aug08, i got my CT contrast done , which evidenced round masses mediastinal and extensive hilar adenopathy. Post this the chest phy recommended a series of tests which included Montoux, TB Gold test, ACE, IGE, CBC, Platlet, PT test, PFT, Abdomen Ultra sound.

Liver/pancreas were normal.

Ultra sound was normal. TB Gold (gamma) test was negative. PFT test was normal ( score was 149 approx ) , Montoux was negative.

I went to another famous chest specialist/surgeon and showed all my reports. Unfortunately he said Lnode biopsy is not possible as the nodes/round glands seen in CT plates are quite deep. Hence recommended me to go for two options.

Options no 1- To adopt a empirical approach ( judgemental ) - i.e take 6-8 medicnes , probably meant for mild TB or sarcoidoisis ( corticosteriods) or go for another test which is called I guess PET test where a glucose dye is injected while CT is done. This test again he said has only 25-33 % success rate, but if am fortunate can give the doctor firm diagnosis.

My worry - I asked doctor if this is lymphoma or what or is it TB or Sarcoid ? Currently I have no problems like fever, weight loss, lossof appetite, no visible nodes seen around neck area, arm pits, groin etc .

I am unable to interpret the reports and see no confidnce in what doctors say. Doctors even says these glands sometimes go on their own within 2-3 months.

I remember I had severe cough from August 2007 till atleast Apr 2008 and i did not went to the doctor and took only ususal cough syrups and my profile is consistent traveling around the globe , like visiting Taiwan, Shanghai, Swiss, UK, Greece, Malaysia etc , as even i would speak something, i would cough, or laugh even now loud, then i cough , sometimes I get weezing as well in the night post my dinner.

What should I do, kindly help as i am quite health concious and would like to get rid of these glands even I have no trouble currently.

Many thanks in advance for your support.

Anupam

[National Jewish Health]

There are conflicting reports about the value of CT scan and positron emission tomography (PET) scan imaging.  These include reports of false-positive tests for malignancy.  In some instances, the clinical and radiologic imaging tests are so strongly suggestive of sarcoidosis, that a biopsy may be deemed unnecessary.  This is especially true for stage 1 sarcoidosis, in which the lungs themselves are spared.  Clinical presentation of minimal symptoms, mediastinal lymphadenopathy, especially bilateral hilar and right paratracheal lymphadenopathy, with normal parenchyma on CT scan strongly suggests a diagnosis of sarcoidosis and biopsy is not considered necessary.  Your situation is somewhat consistent with that in that you have lymph node enlargement but are symptom free.

If a biopsy is deemed necessary, the tissue can be obtained by either mediastinoscopy or by video assisted thoracic surgery (VATS).

You would do well to seek the opinion of a pulmonologist, a non-surgeon lung specialist, especially one with much experience with sarcoidosis.  You can ask the specialist about his/her experience in advance.

[anupam004]

Thanks for your comments. The final report I just received it today from the second doctor, which says that the nodes are nacrotic in nature and strongly suggested this to be the case of TB, albeit the same patterns are also seen in sarcoid patients.

I showed these reports to my Chest specialist who firmly said that this is TB since glands are not nacrotic in sarcoidoisis. Fortunately or unfortunately for last 4-5 days I also noticed swelling on my left lyph node behid the ear ( end of jw) and showed it to the chest specialist, and he said immediately go for FNA, I got it done and the result showed ' tuberculous lymphadenitis ', which further confirmed my doctor's diagnoisis as TB

He has given 15 days anti-TB drugs and is confident that the small glands will go off subsequently in 3-4 months, as he will obtain X-ray first after 2 weeks

Trust I am on right track....

Thanks