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Having pain and nausea. CT scan showed swollen spleen and abdominal lymph nodes. Blood test normal. Having pain in groin. Guide?

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For past 4 months, pain in left flank/nausea. CT scan 1 (4 mos ago) showed a swollen spleen and abdominal lymph nodes. CT scan 2 (2 mos ago) showed spleen had returned to normal, but still had one swollen lymph node in my chest. Bloodwork/urine all fine. Last month or so have developed pain over my left hip/groin/ovary as well. In addition, I have had some pain in my sternum/right side, but that is off/on. Had upper endoscopy - no ulcer, minor gastritis. Had an 'attack' one evening where I was up all night with extreme pain under my sternum and hurt to breathe deeply or move. At this point, my left side pain is basically constant, and right side/mid section pain is off/on. My guess is possible gallbladder (after all my tests have ruled out otherwise) but what about the hip/groin pain? (Have had SI joint issues in the past, wondering if it's inflamed?) Any ideas? I am mostly worried about the waist/hip/groin pain as that seems to be a new addition...
Posted Tue, 25 Jun 2013 in General Health
Answered by Dr. Luchuo Engelbert Bain 1 hour later
Hi and thanks for the query,

The periodic changes in the sizes of the spleen and lymph nodes are favorable in your case. During viral infections, or some bacterial infections, the system might initially react by increasing an immune response, with at times increased spleen and mobilization of white blood cells and anti body responses leading to an increased size in the lymph nodes. It should however be very clear and careful in the manner in which these results are interpreted. One needs to be sure of the technique used and accuracy of the measurements. Clinical presentation is important. The worsening of a clinical state or onset of new symptoms might warrant a reevaluation.

The onset of chest lymph node without any respiratory symptoms like a cough, shortness of breath could not be very important. Presence of fevers, chronic cough, weight loss should lead to a formal exclusion of pulmonary TB, Hodgkin s disease, other lymphoma or tumors.

Chronic left flank pain, in association with abdominal lymph nodes form the start should make one think of abdominal TB or intrabdominal tumors. These need formal exclusion. An abdominal ultrasound might be required to make a diagnosis of any fluid containing structures. Pain across the left groin should lead to the suspicion of chronic appendicitis, which is common.

However, the pain you describe looks more of a bone tissue lesion, and might not be associated with the abdominal symptoms. An X XXXXXXX if the groin, blood tests especially the white blood tests, markers of inflammation are mandatory after a proper clinical evaluation to orient diagnosis and treatment.

I strongly suggest you book an appointment with an internist.

Best regards,
Luchuo, MD.
Above answer was peer-reviewed by
Follow-up: Having pain and nausea. CT scan showed swollen spleen and abdominal lymph nodes. Blood test normal. Having pain in groin. Guide? 1 hour later
Thank you. After 2 ct scans, wouldn't tumors be ruled out since no mention of them after either one? All was fine except slightly swollen spleen and lymph nodes. Isn't appendicitis on the left side? Have an ultrasound scheduled soon so should know more soon. Forgot to mention it have intermittent pain under both sides of rib cage. Sometimes crampy, sometimes a burning feeling.

Any chance groin pain is connected to si joint issues? My low back/hip on that side is also very painful right now. Thanks again.
Answered by Dr. Luchuo Engelbert Bain 5 hours later
Hi and thanks for the query,

It is important to note that CT scans do not detect all tumors. Reasons why other techniques or measures are usually required to supplement the CT scans.

The appendix is located in the RIGHT iliac fossa (generally, the appendix is slightly below the umbilicus (navel) and to the right.

With the intermittent pain around the mid cage region, it is reasonable therefore to do a good clinical evaluation to exclude peptic ulcer disease, gastroesophagal reflux or gastritis. It s worth undertaking another fibroscopy.

I think the pain in the groin could also be of bone/joint lesion origin. Reason why I propose a clinical evaluation, some blood tests to exclude rheumatologic disease. An X XXXXXXX could also be of help.

I suggest more shall be done when you XXXXXXX your internist.

Best regards,

Luchuo, MD.

Above answer was peer-reviewed by
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