Tuesday, November 14, 2006

LUL nodule with ipsilateral LAD

25 yo female with no PMH presents with above.
She was well until April when she travelled to Phoenix to visit friends. When she returned, she had a bad URI. Her PCP obtained a CXR which showed a shadow in the L hilum, and a CT was recommended.
The CT was from an OSH and resembles the CT shown below. The L hilar fullness is a node clearly visualized in the OSH CT; the CT I show is without contrast (she got hives after the first CT). The rec on the CT was to obtain a repeat in 3 months. This is the 3 month CT.

She is currently asymptomatic other than a 20 lb weight loss since 4/06. She has not changed her eating habits or exercising habits.

PMH: Non-smoker but moderate second-hand smoke from her parents.
















Labs: CBC, chemistries, U/a are all normal.

What would you do?

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

Arenberg said...

Mike, this sounds like "Valley fever" to me. Do you have any serologic mojo?

Mike L said...

Fungal serologies are all negative.

Jennings said...

I agree that this is likely fungal (and self limited), despite the negative serologies. I would repeat a ct in 3 months if she remains asymptomatic.