Monday, August 14, 2006

Outside case: Adenopathy

This was submitted to us:
34yr.old female w/ previous rt low lobe nodules since 2001 CT revealed the nodules while patient had chickenpox.
New CT in 2006 shows new node on lt. upper diaphragm. Last CT 6mo. prior didnt show nodule, which is uncalcified unlike rt. lung nodes.
PT. has nightsweats wt. loss chronic pelvic abdominal pain jointpain/swell/stiff no appetite ab.bloat chronic urinary symptoms and UTI.
Now with SWOLLENLYMPHNODES W/LYMPH SURFACING AND RUPTURE ON NECK BACK OF HEAD BEHIND EAR. PT. is 11/2 ppd smoker of 13yrs. PET done 4/06 and no malignant chest activity. labs almost normal.

2 comments - CLICK HERE to read & add your own!:

Arenberg said...

I'd need to see the films, but it sounds like this nodule(not lymph node?)is just above the diaphragm. If so, these often represent localozed pleural thickening or atelectasis. I have seen many of these pleural based nodules on/near the diaphgragm and I have never seen one progress or grow.

The systemic symptoms sound like an infectious (chronic pyelo/PID) or collagen-vascular disease (SLE, RA, MCTD etc,), noneof which I can easily tie in with this CT abnormality...the kinds of infections that cause constitutional complaints almost never occur confined to the base of the lung (fungus, AFB, etc.,) If you could post the CT scan, myself or others might have some additional thoughts pop into our heads.

Jeff H said...

SWOLLENLYMPHNODES W/LYMPH SURFACING AND RUPTURE ON NECK BACK OF HEAD BEHIND EAR--sounds to me like a biopsy, or at least culture, is necessary. I'd be concerned about AFB.