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Coughing. PET scan shows extensive Pulmonary abnormalities. Scheduled for EGD. Need suggestion

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Practicing since : 2006
Answered : 554 Questions
Hi, to you all and thank you for taking my question but, here goes -- my symptoms started about May with a pesky non-productive cough and I notified the PCP who said to call back in two weeks , if I still had the cough. The cough persists and I called her back and ordered Azithromycin and told me to get a Chest Xray which showed bilateral intersticial Pneumonia and bilat. pleural effusions. The Azith and pain meds did not help at all. I was referred to a Pulmonology and he ordered the CT Scan and the Prednisone and Levaquin --- which finally gave me some relief. I forgot to mention the coughing got worse and I was coughing a lot and lots of coughing spasms. Subsequently, I had a PET Scan done which showed extensive Pulmonary abnormalities, including nodular opacities, parenchymal scarring changes and mild mediastinal lymphadenopathy and further characterization desired to rule out lung cancer. Conclusion from PET Scan is Low level labeling associated with multiple nodular poacities scaterred in both lungs, benign etiology is favored .Modrerate sized Left pleural effusion has marginally enlarged and does demostrae diffuse low-level labeling on PET. Pathologic focal labeling in the midesophagus, without obvious mass on the CT. Esophagram is recommended for further evaluation, as PET characterisics are not typical for benign cause such as esophagitis. I have an EGD scheduled, so, I am hoping we can get some answers soon. I am SOB with little exercise, very lethargic , sl. cough returning after decreasing Prednisone as the Pred. was causing major tremors and did have two incidents of severe chest pressure when I went off the Prednisone. I feel quite ill and want to know what you think is going on and if there are other tx's I should be looking into? By the way, I am a Retired RN Thanks for you attention, Jeannette Romano
Posted Wed, 30 Oct 2013 in Lung and Chest disorders
Answered by Dr. Satyadeo Choubey 14 minutes later
Brief Answer:
Pleuarl fluid examination must be undertaken

Detailed Answer:
Thanks for your query,
It is very important for any pulmonologist to get a histopathological diagnosis of the existing disease particularly if malignancy is suspected.
Apart from scheduled esophagogram and further workup, I strongly recommend to undergo pleural fluid diagnostic tapping and further workup ( routine microscopy, protein, LDH, amylase, triglyceride, ADA, and above all malignant cytology). In your case a diagnostic bronchoscopy and brush cytology must be done.
What I feel is you must have elaborated the symptom especially about leg swelling, increasing of breathlessness while lying down, history of jaundice, any kidney problem and serum urea and creatinine.
If you feeling too much shortness of breath, may undergo therapeutic pleural aspiration.

Best wishes
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