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Had a bilateral mastectomy resulting in left side lymphedema. CT scan showing scattered non specific lymph nodes in neck. Is this normal?

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I had a bilateral mastectomy resulting in left side lymphedema 3 years ago. A lat flap reconstructive surgery was performed on the right side 1 year ago. 5 months after the lat flap surgery, I over exerted myself and ended up with an infection in my chest and a pain up the right side of my neck and behind my ear. I was treated with cipro, but the pain in my neck has never completely subsided. A CT scan ordered by an infectious disease doc showed "scattered non specific lymph nodes" in my neck. Neither the ID doc nor the radiologist seemed concerned about these nodes.
I am scheduled for another reconstructive surgery on November 13 and I am afraid that these nodes are indicative of an infectious process even though none of the blood work indicates infection. (I do have a low white blood count probably due to the tamoxifen) Could the nodes simply be a result of the over taxed lymphatic system and nothing to worry about?
Posted Thu, 7 Nov 2013 in Breast Cancer
 
 
Answered by Dr. Anjana Rao Kavoor 55 minutes later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi
Thanks for writing in to us.

On CT scan, a normal lymph node usually measures <1 cm in size, has a smooth and well-defined border, and shows uniform, homogeneous density or signal intensity. Most benign nodes have a central fatty hilum, which has a distinctive feature on CT. Based on its anatomic location, the shape of a normal lymph node may vary. Usually normal nodes tend to have an oval or cigar shape. The primary yardstick for nodal staging by CT is lymph node size.

As you might be aware of, a lymph node itself can get infected when overwhelmed by the infection it is trying to fight. The node may become swollen and tender to the touch, and the overlying skin may be red and warm. Infected nodes (called "lymphadenitis") are fairly common and may be treated with an antibiotic, warm compresses and over-the-counter pain relievers such as acetaminophen or ibuprofen. If untreated, infected lymph nodes may progress to an abscess (pus collection) or spread bacteria to the overlying skin or into the bloodstream.

If you do not have any indicative features of clinical infection and the size of the largest mentioned lymph nodes is within acceptable limits, I do not see any need to worry for them. However, please be aware of any palpable neck lymph node and should there be any increase in size or number with or without associated inflammatory signs, it must be brought to the notice of your doctors.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
Follow-up: Had a bilateral mastectomy resulting in left side lymphedema. CT scan showing scattered non specific lymph nodes in neck. Is this normal? 19 minutes later
What could be causing this pain in my neck and behind my ear? Could the lymphedema be causing the "scattered non specific nodes" showing up in the CT of my neck? Did the lat flap surgery further compromise my lymphatic system?

 
 
Answered by Dr. Anjana Rao Kavoor 6 hours later
Brief Answer:
Please find detailed answer below

Detailed Answer:
Hi XXXX,
Thanks for writing back with an update.

Lymphedema is an abnormal buildup of fluid that causes swelling, most often in the arms or legs. The condition develops when lymph vessels or lymph nodes are missing, impaired, damaged, or removed. In bilateral mastectomy, axillary lymph nodes are cleared and this causes lymphedema.

Lymphedema is the pooling of lymph due to absence of lymph nodes in your case. Scattered lymph nodes are not due to lymphedema. Lymphedema treatments vary, depending on the stage and cause of the illness. The most important aspect of treatment is learning how to care for your general health. Your doctor or nurse should teach you how to follow your prescribed treatment.

If the initial signs and symptoms of swelling are caused by infection, antibiotics may be prescribed. Other treatments may include bandaging, proper skin care and diet, compression garments, exercises, and manual lymphatic drainage, a gentle form of skin stretching/massage.

The flap surgery did not compromise your lymphatic system. You must take precautions and treatment of your lymphedema and prevent it from progressing further.

Lymphedema cannot be cured. However, with proper care and treatment, the affected limb can be restored to a normal size and shape. In addition, lymphedema can be treated and controlled so that it does not progress further.
If left untreated, lymphedema can lead to increased swelling and a hardening of the tissue, resulting in decreased function and mobility in the affected limb. It can also lead to chronic infections and other illnesses.

As the lymph nodes are not metastatic in any way, the infectious disease doctor and radiologist are not concerned much about that.

I hope this helps.
Do write back in case of doubts.

Dr.A.Rao Kavoor
Above answer was peer-reviewed by
 
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