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CT scan showed swollen mediastinal lymphs in lungs. Had bronchial infection and RA factors. Treatment?

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Practicing since : 1979
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Hi last week I had a ct showed swollen mediastinal lymphs in my lungs. Neck lymphs were normal. The rest of the lungs looked normal. This CT was done right after a severe bronchial infection.The doctor said that I showed pneumonia that was resolving....A few years ago I had swollen paratid glands that stayed swollen for several months . It looked like i had the mumps. The first time it happened i was feverish and weak. This happened a few years in a row. I went to a doctor who couldnt get to the bottom of it. Mom had RA. My blood shows the RA factors. I am trying to sort out the various conditions that this could signal. Also I had 2 blood tests ( one for general checkup last month) and one yesterday. They looked normal.
Another thing also, this coincided with several days of inside house painting, same also when the paratid glands were swollen both times. By the way these were also CT at the time but not my chest cavity.
Posted Mon, 2 Sep 2013 in Lung and Chest disorders
Answered by Dr. Shashi Dangwal 1 hour later
Brief Answer:
Need more information.

Detailed Answer:

You have not mentioned why did you get a CT chest done? Are you having symptoms like fever, cough, wt loss, breathlesness, joint pain etc?

There are many causes of mediastinal lymph gland enlargement. Commonest are bacterial infections like TB, fungal infection like histoplasmosis, collagen vascular diseases like sarcoidosis and certain malignancies like lymphomas. Sarcoidosis may be a possibility as your RA factor is positive. You may not be having any symptoms and it may be an accidental findings.

To establish the diagnosis, lymph node biopsy needs to be done beside certain other tests. Since there are no glands in the neck, biopsy of mediastinal gland is required which has its inherent risks. How far one has to go ahead with the investigations, depends on many factors including symptoms.

I suggest you consult a pulmonologist who will examine you in toto and then decide on investigations after weighing the risks vs benefits.
Above answer was peer-reviewed by
Follow-up: CT scan showed swollen mediastinal lymphs in lungs. Had bronchial infection and RA factors. Treatment? 22 minutes later
Thank you Dr. Danwal for your prompt reply.
When I went into the doctor ( walk in clinic) for my 20 day congestion and cough, I mentioned this small lump under my mandibular that I had since the mid 90s. It was imaged a while back and thought to be a salivary gland. It was an afterthought. He thought that I should just get a ct in case it was a cyst.
I was not worried at all about this scan. But then they called and wanted me to go in immediately for a full chest ct after seeing signs of this lymphadenopathy in the mediastinum. The next radiologist read it as " diffuse,moderately enlarged hilar/a "minimal" reticulonodular infiltrate on rt side with scattered pulmory nodule. By the way I feel pretty good except for this anxiety that is keeping me up. My cold is gone. My question is : could I just have this all along and it be related to something other than cancer? Also, occasional joint pain,( I hike 4 miles per day) i did lose weight, 5 pounds but I cut back on cheese and also got put on thyroid meds last fall.

I am almost a complete vegetarian( ethical reasons)

No fever but at times I don't feel like I have a productive breath with inhaling. This is sporadic.
I have allergies and use a nasal cortosoid spray.
No history of any cancers in any relatives until this past XXXXXXX my younger brother got diagnosed with aggressive prostate. (He works as a research scientist) I need to stay healthy to support his healing process.
Answered by Dr. Shashi Dangwal 2 hours later
Brief Answer:
Consultation with pulmonologist.

Detailed Answer:

Thanks for posting further inputs.

In view of the CT findings of mediastinal lymphadenopathy with minimal reticulonodular infiltrates on rt side, i am of the opinion that sarcoidosis could be a possibility.

You may or may not be having any symptoms( breathlessness and dry cough could be because of asthma or sarcoidosis). Do not worry about malignancy as in your case it appears highly unlikely.

Has the lump under mandible gone. If still persisting, it could be a node which biopsied or FNACied.

As suggested earlier, you should consult a pulmonologist who can guide you correctly.
Above answer was peer-reviewed by
Follow-up: CT scan showed swollen mediastinal lymphs in lungs. Had bronchial infection and RA factors. Treatment? 37 hours later
Dear Dr. Dangwal,
I have called to get an appt. with a pulmonologist. I live in Anchorage , Alaska and they are very busy here. The lump under my jaw is still there. It is the size of a kernel of corn, moves freely, neither ct highlighted it as a worry. However I still will seek a biopsy on this.

I wanted to tell you that you have managed to calm me with your replies. While I realize that this is not a diagnosis however your professional insight has helped me immensely.
A very heart felt thank you. Maryann
Answered by Dr. Shashi Dangwal 3 hours later
Brief Answer:

Detailed Answer:
Hello XXXX,

From your description the lump under your mandible does not appear to be of much significance. It may be a normal sub mandibular lymph node.

I am glad that you are feeling relieved with what ever i had to say. Do consult a pulmonologist and i am sure when he sees you in person, he may be in a better position to judge your case in detail and advise you correctly.

Above answer was peer-reviewed by
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