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Having horrible pain and swelling in lung area. Suffer pain. Suggested small nodules in lungs. What should I do?

DOCTOR OF THE MONTH - May 2014
May 2014
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Radiologist
Practicing since : 2002
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Hello. I am having horrible pain and swelling in the right lung area, also swelling in the right arm and right leg. I am am in such hideous pain. This has been going on about one year. I had a CT of the THORAX without contrast on 12-12-2012 by order of pulmonologist. I will attache the copy of the CT report. He says there are three very small nodules on my right lung, one with is contiguous with a blood vessell. My body keeps bringing on fluid on the right side of my body. And today I think I am dying of the swelling and pain. Pulmonologist says I need another CT of the THORAX this coming December again. Please tell me truthfully if you think I have cancer of the lung or something. I am 62 year old diabetic female. CABG X 3 in 2002, and two stents, and horible mususco skeleto problems, which include severe bulging disks up and down my spine and I need to have a laminectomy at L5 S1. I will attach the MRI reports here as well. I have written a few weeks ago about the bone problems to another doctor at your company, and I was very happy with his answers regarging the musculoskeletal problems. But with the horrible lung pain do you think I might have lung cancer or bone cancer. Fluid is all over my right lung and my right side of body.
Posted Thu, 17 Oct 2013 in General Health
 
 
Answered by Dr. Vivek Chail 2 hours later
Brief Answer:
CT scan chest is to follow up on nodules.

Detailed Answer:
Hi XXXXXX,
Thanks for writing in to us.

Glad that you have liked our services earlier.

I have gone through your medical history in detail.

A lung nodule, when first diagnosed, is often a cause of worry to the patient and doctor as until biopsy is done and pathological diagnosis is made, treatment cannot be decided. However, there are certain tell tale signs in a nodule which point towards a benign condition. I would like to discuss that with you and assure that its not something scary that you have in your lung.

1. A solitary pulmonary nodule is defined as a discrete, well-marginated, rounded opacity less than or equal to 3 cm in diameter which may be benign or malignant. Lesions larger than 3 cm are considered masses and are treated as malignancies until proven otherwise. As yours is in size ranging from 2 to 3.5 mm, it is very small indeed to be malignant.

2. A doubling time of less than 1 month or longer than 18 months makes malignancy unlikely. If your nodule is not growing too fast then it is not too worrisome.

3. Chest radiographs may demonstrate calcification, which often indicates that the lesion is benign. There is no such finding in your report.

4. Border of the nodule: a well-defined, smooth edge may indicate a benign lesion. This is a technical point.

As the above are technical factors that will be best understood by doing CT scan and comparing with earlier scans or radiographs, it is important for you to get a CT scan of your chest done as per your doctor.

There is no fluid (pleural effusion) mentioned in the report that you have sent. If it is a latest development, I would like to see your recent Chest X XXXXXXX and report. Since you have diabetes, the possibility of water in chest due to infection needs consideration, if applicable.

Your MRI findings do not suggest any suspicious cancer.

Hope your query is answered
Waiting for an update from your end.

Regards,
Dr.Vivek.
Above answer was peer-reviewed by
 
Follow-up: Having horrible pain and swelling in lung area. Suffer pain. Suggested small nodules in lungs. What should I do? 16 hours later
Dr. Chail, thank you so much for writing back. I have uploaded a chest x XXXXXXX report from Urgent Care done on Sept. 3, 2013. this one does not show the nodules but the CT of Thorax does. Sorry but I do not have the actual chest x XXXXXXX film to send. But today the swelling in the right mid thoracic area is really bad and even swelling n right arm and leg. Also, I forgot to tell you that seems like all my lymp nodes in my body are all swollen. I cannot get any doctors in the US to listen to me. If you question the doctors in US they get very angry at the patient. Its disgusting. Then they say they to give me some pills for depression and send me home. Can you go over the CT of the THORAX AGAIN please? What does it mean Linear atelectasis versus scarring? Also what does it mean ASCENDING AORTA IS AT UPPER LIMITS OF NORMAL? MAIN PULMONARY ARTERY UPPER LIMITS OF NORMAL?? What does all this mean? Am I to be very freightened? I think I understand more of the nodules. You say they are very, very small and prolly not anything bad. I have had them for long time. You calmed my fears about that. I wish you could be here in the US to be kind and caring and take care of all of us. I will wait for your answer. On a scale of one to ten, my pain is ten and that ten is for 24 hours a day. I do not take pain meds because of the severe colon issues which causes the constipation to be worse. So I suffer every day with all these issues. My main worry right now is all the swelling in the right mid thoracic and right arm and right let.
 
 
Answered by Dr. Vivek Chail 11 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Hi XXXXX,
Thanks for your appreciation and writing in to us with an update.

I have gone through the chest X XXXXXXX report (Urgent Care) done on Sep 3 2013 and find atherosclerotic vascular calcification which is due to your age and the post sternotomy sutures seen post CABG surgery. I suppose the nodules are not visualized on your chest X XXXXXXX and you should not worry about that. I would like to point out that there is no mention of any fluid in your lungs in the report and would like to clarify with you if there was any fluid in the chest at any point in time (medically termed as pleural effusion).

I have given thought to your history of CABG in the year 2002 and would like to know if the graft was taken from your right XXXXXXX mammary artery. This might help me to connect the right mid thoracic swelling with your surgery in the past. Multiple grafts if taken from your right arm and leg might also need to be considered in the causation of welling.

The mention about ascending aorta and main pulmonary artery measuring at upper limits of normal is acceptable at your age and need not be a cause of concern.

The CT scan thorax done 12-12-2012 shows no lymph node enlargement in the thorax. Lymph nodes may enlarge due to infection or other causes and need to be confirmed or ruled out after complete clinical examination and with the aid of investigations like ultrasound scan and CT scan if felt necessary.

The colonic issues (including constipation) need to be correlated with your diverticulitis, diabetes and medications like Xanax. I would suggest application of any ointment containing a pain killer and muscle relaxant combination. It is important to be clinically examined by your doctor at the same time.

Hope your query is answered
Do write back in case of doubts.

Regards,
Dr.Vivek.
Above answer was peer-reviewed by
 
Follow-up: Having horrible pain and swelling in lung area. Suffer pain. Suggested small nodules in lungs. What should I do? 11 hours later
Thank you for getting back to me. They took the vein from my LEFT LEG during the CABG in 2002. No swelling there. Can you please address the swelling of my right mid thoracic, my right arm, my RIGHT BREAST is swollen. Also swelling in RIGHT groin and leg. It all feels like fluid all over the right side of my body. pain is so severe in my body, I dont know what to do. so sick all the time.

do you think my lymph nodes are cancer? Could it be breast cancer? I am just so sick, I live in constat pain, do not want to eat or drink even water. when I go to doctor or urgent care, they just send me home and give me a pain shot. i do not want pain shot. I want to find out what wrong.

I thank you for your valuable time and writing back to me with your evaluation. Thank you for being kind. I am at the end of my rope.
 
 
Answered by Dr. Vivek Chail 11 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Hi XXXXX,
Thanks for writing in with an update.

First I would like to write about the atelectasis and lung scarring finding on CT. This is very minimal collapse at sub segmental level and can be seen in elderly patients. No specific importance is attached to it in your situation so please do not worry about that.

Speaking to the swelling on the right side of the body I would like to discuss that in detail. After reviewing medical literature, I find that unilateral edema (swelling) may occur after right-sided laparotomies in patients with ascites (more seen in cirrhotic patients). This unusual pattern of fluid retention apparently develops as a consequence of operative communications between the peritoneal cavity and the subcutaneous tissue, especially with disruption of deeper layers of the wound. Ascitic fluid passes through these fistulas into the subcutaneous tissue and dissects to dependent portions of the body, including sometimes the ipsilateral lower extremity (same side leg). Though it is seen more in patients having cirrhosis of liver, these phenomena may occur in noncirrhotic patients with postoperative ascites. It is notable here that your CT Thorax report mentions cholecystectomy (gall bladder surgery) and any event surrounding your gall bladder removal surgery needs consideration leading to swelling of the right side of your body and including right leg. This opinion of mine is purely based on medical literature reviewed but your clinical examination is equally important to support my views.

Regarding lymph nodes, I do not find mention of any enlarged lymph nodes in any of your reports and would recommend clinical examination to confirm the same. symptoms in most cancers are swelling anywhere in the body associated with loss of weight.

In conclusion, I would like you to calm down regarding your health problems and that they are really not as bad as you might have earlier thought. I support your complains of pain and discomfort and pray that they can be resolved by proper medical treatment and a bit of hope and will power.

Hope your query is answered
Do write back in case of doubts.

Regards,
Dr.Vivek.
Above answer was peer-reviewed by
 
Follow-up: Having horrible pain and swelling in lung area. Suffer pain. Suggested small nodules in lungs. What should I do? 9 hours later
Dr. Chail, thank you for writing back. I have always questioned liver problems with a few of my old doctors. They have always told me that the swelling on the right side of my belly and across the abdomen is due to the severe colon problems and diverticulitis several times. But I have always questioned that. Every time I eat, the abdomen swells immediately, but they keep telling me its due to years and years of the chronic constipation. Two years ago, I had severe pancreatitis. The lab work came back which was very high on the amalyse and lipase???. I do have regular blood work done, seems everything normal. Can you suggest any names of the blood tests I should ask for regarding the liver. Also, I have attached my most recent lab work of September 3, 2013. Would you please check this over? Thank you. For the past five days, it seems that I have lost about five pounds. I currently weight 235 pounds. Age 64 and female diabetic, and heart disease, also right coronary artery is blocked 100 per cent, and is NOT fixable per my cardiologist. but he told me not to be concerned, he said if i had a heart attack i prolly wouldnt notice it. Can you imagine? Thank you and will wait to hear back from you. Thank you for your kindness and concern about me.
 
 
Answered by Dr. Vivek Chail 14 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Hi XXXXX,
Thanks for writing in again.

I have gone through your reports in detail. The CT scan thorax does mention mild fatty changes in your liver which might be acceptable keeping in mind your body weight. It does not convey any serious disease. At the same time, lab reports on liver function tests like SGPT, SGOT, Total bilirubin and Alkaline phosphatase are all normal. Therefore going in for further testing for liver disease is not required right now.

It is not easy to comprehend your 5 pounds weight loss in 5 days. You may seek guidance regarding weight management for your doctor. This needs to be confirmed and investigated. I suppose you are keeping your fluid and diet intake normal. Your random sugar level does indicate a higher value at 183 but this can be controlled by your insulin and diet.

Pancreatitis can recur at any time and the best diagnosis is made by two blood tests that measure enzymes are used to diagnose an attack of pancreatitis.
These tests are as you are already aware:
Serum amylase. An increase of amylase in the blood usually indicates pancreatitis.
Serum lipase. Sudden (acute) pancreatitis almost always raises the level of lipase in the blood.
The enzyme levels rise in about 24 to 48 hours into the illness and patient has severe pain.

Having a 100% right coronary block after CABG surgery is difficult to treat. Your cholesterol tests need to be done regularly and medications taken appropriately. Your CKMB and Troponin I levels are normal as per 3rd September 2013 report and that rules out any acute heart condition at the moment. However, please do not ignore any symptoms of possible heart attack in future. Since you are a diabetic, if you have discomfort, shortness of breath and sweating even without chest pain, you must be checked for a heart condition as it has been done this time. An emergency ECG and echocardiography will also be of help. Going by what your doctor says, I would opine that you might not have the severe chest pain but that should not make you unconcerned. I repeat again, if you experience shortness of breath, discomfort and sweating a heart evaluation becomes important immediately.

Hope your queries are answered.
Do write back in case of doubts.

Regards,
Dr.Vivek.
Above answer was peer-reviewed by
 
Follow-up: Having horrible pain and swelling in lung area. Suffer pain. Suggested small nodules in lungs. What should I do? 19 hours later
Thank you for responding. And I appreciate you information and letting me know the answer to my question. My next question is probably the most important. For the last three weeks, I have horrible pain in both groins and both legs. Groins and legs hurt so bad I cannot barely walk now at all. I dont know what to do. I know I have vascular disease. I am afraid of any kind of amputation. It feels like both groins are full of fluid or something. I hope I dont have blood clots. Both groins and legs are very hot, and abdomen is very hot to the touch. My legs do not want to hold me up anymore. Today is the worst. Also down the middle of the abdomen, it feels very cold to the touch. I can barely stand this pain. Nothing will stop the pain. I dont feel like I can go on much further than this. I thank you and hope for your reply. Oh, I do NOT USE ALCOHOL OR DRUGS. I am only a disabled XXXXXXX with diabetes and heart disease trying to get help for my questions and symptoms. Tonight I am very scared as I feel there is no circulation in my legs, and abdomen is very swollen.
thank you.
 
 
Answered by Dr. Vivek Chail 5 hours later
Brief Answer:
Please find detailed answer below.

Detailed Answer:
Hi XXXXX,
Thanks for writing in to with your new query.

I would suggest you to get examined by a vascular surgeon and if necessary, a Doppler ultrasound of arteries and veins in both legs may be done. This will show the flow of blood from the heart to the farthest points in the legs and also the return of blood through the leg veins. It is essential to do this investigation if you are having pain and raised temperature on your legs. I reassure you that the situation is not as bad as requiring amputation but medications might help and that is better prescribed only after consulting a vascular surgeon. It can also be due to diabetic neuropathy, details about which are given below.

About the increased temperature over abdomen and cold sensation down the middle of the abdomen, it could be due to your bowel related problems. Sometimes these do happen in diabetics due to neuropathy. Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling.

I pray that your diabetes is under strict control and your problems are looked into by your treating doctors.

Hope your queries are answered.
Do write back in case of doubts.

Regards,
Dr.Vivek.
Above answer was peer-reviewed by
 
Follow-up: Having horrible pain and swelling in lung area. Suffer pain. Suggested small nodules in lungs. What should I do? 9 hours later
Thank you Dr. Chail for writing back. I will immediately get an appointment with a vascular physician. And I also have a new appointment for a neurologist on October 1st. And then I will go from there. Thank you for pointing me in the right directions of my health issues. I think you have SAVED MY LIFE. And you have been able to calm a lot of my fears. Something that doctors here in US cannot do. I wish someday to XXXXXXX you and shake your hand. I will promise to write to you after I see all my new appointments for neurology and I just obtained a new endocrinologist. Without your kind attention and concern, I would not have made these appointments. May God bless you kind Dr. Chail. I will write to you again to let you know what happens after all the new work ups. Thank you and God to bless and keep you.
 
 
Answered by Dr. Vivek Chail 14 hours later
Brief Answer:
Thanks and will be glad to help you out again.

Detailed Answer:
Hi XXXXX,
Thanks for writing in to with updates.

Glad that you have made an appointment with your neurologist and wish that your new like to shake your hand and I pray to God to give you a very long and healthy life.

I will be happy to answer any queries that you may have after your appointments with doctors at your end.

Regards and best wishes,
Dr.Vivek.
Above answer was peer-reviewed by
 
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