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I Would Like To Have AHemotologist Explain This Report To

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Posted on Thu, 29 Oct 2020
Question: I would like to have aHemotologist explain this report to me and let me know if it could be cancer.

Report



CT-SOFT TISSUE NECK POST IV CONTRAST



History: Right-sided neck mass/swelling. Recent ultrasound reportedly demonstrated a

right level IV lymph node measuring 3.2 cm



Technique: The patient was examined and a marker placed over the area of clinical

concern. Following the administration of 85cc of Omnipaque 350 intravenous contrast axial

images were obtained through the neck with sagittal, axial and coronal reformatted images

then generated from the axial acquired data. This study was performed using automatic

exposure control (radiation dose reduction software) to obtain a diagnostic image quality

scan with patient dose as low as reasonably achievable. One or more of the following dose

reduction techniques were used: Automated exposure control, Adjustment of the mA and/or

kV according to patient size or Use of iterative reconstruction technique. The

administered radiation dose was 1.9 mSv.



Renal function: Per ACR guidelines and Zwanger-Pesiri policy, a creatinine level was

performed prior to the examination. Results were as follows: Creatinine = 0.4 mg/dL.



Prior examinations: Ultrasound dated September 7, 2020.



Aerodigestive tract: No primary aerodigestive tract lesion is seen.



Lymph nodes: No pathologically enlarged lymph nodes are seen at the following locations:



-Right level III measuring 2.3 cm in craniocaudad dimension, 9 mm left-right dimension and

5.5 mm anterior-posterior dimension (see axial image #61 of series #7 and sagittal image

#46 of series #4).

-Right level IV lymph node that measures 3.4 cm in craniocaudad dimension, 1.7 cm

anterior-posterior-posterior dimension of 5.8 mm in left-right dimension (see sagittal

image #47 of series #4, axial image #309 of series #6 and coronal image #43 of series #3.



Multiple other lymph nodes are seen in the neck which are all less than 1 cm in diameter.

All lymph nodes are solid without necrosis or extracapsular spread of disease.



Parotid glands: The parotid glands have a normal size and enhancement pattern. No parotid

masses or ductal dilatation is seen. No radiopaque calculi are identified.



Submandibular glands: The submandibular glands have a normal size and enhancement

pattern. No submandibular gland masses or ductal dilatation is seen. No radiopaque calculi

are identified.



Thyroid gland: The thyroid gland is normal in size. There are no thyroid nodules.



Thoracic inlet: Normal.



Lung apices: Normal.



Brain: Limited evaluation of the brain parenchyma does not demonstrate any mass, mass

effect, edema, hemorrhage or infarct.



Orbits: No orbital masses are seen. The globes, extraocular muscles and lacrimal glands

are normal.



Paranasal sinuses: Normally developed and aerated.



Temporal bones: Normal.



Cervical and upper thoracic spine: Normal.



IMPRESSION:



Pathologically enlarged right level III and right level IV lymph nodes. Histologic

sampling is recommended if they need to be further characterized.



No primary aerodigestive tract lesion is seen.



Signed by: XXXXXXX Panasci MD

Signed Date: 10/6/2020 3:21 PM EDT
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Follow up: Dr. Indranil Ghosh (0 minute later)
I would like to have aHemotologist explain this report to me and let me know if it could be cancer.

Report



CT-SOFT TISSUE NECK POST IV CONTRAST



History: Right-sided neck mass/swelling. Recent ultrasound reportedly demonstrated a

right level IV lymph node measuring 3.2 cm



Technique: The patient was examined and a marker placed over the area of clinical

concern. Following the administration of 85cc of Omnipaque 350 intravenous contrast axial

images were obtained through the neck with sagittal, axial and coronal reformatted images

then generated from the axial acquired data. This study was performed using automatic

exposure control (radiation dose reduction software) to obtain a diagnostic image quality

scan with patient dose as low as reasonably achievable. One or more of the following dose

reduction techniques were used: Automated exposure control, Adjustment of the mA and/or

kV according to patient size or Use of iterative reconstruction technique. The

administered radiation dose was 1.9 mSv.



Renal function: Per ACR guidelines and Zwanger-Pesiri policy, a creatinine level was

performed prior to the examination. Results were as follows: Creatinine = 0.4 mg/dL.



Prior examinations: Ultrasound dated September 7, 2020.



Aerodigestive tract: No primary aerodigestive tract lesion is seen.



Lymph nodes: No pathologically enlarged lymph nodes are seen at the following locations:



-Right level III measuring 2.3 cm in craniocaudad dimension, 9 mm left-right dimension and

5.5 mm anterior-posterior dimension (see axial image #61 of series #7 and sagittal image

#46 of series #4).

-Right level IV lymph node that measures 3.4 cm in craniocaudad dimension, 1.7 cm

anterior-posterior-posterior dimension of 5.8 mm in left-right dimension (see sagittal

image #47 of series #4, axial image #309 of series #6 and coronal image #43 of series #3.



Multiple other lymph nodes are seen in the neck which are all less than 1 cm in diameter.

All lymph nodes are solid without necrosis or extracapsular spread of disease.



Parotid glands: The parotid glands have a normal size and enhancement pattern. No parotid

masses or ductal dilatation is seen. No radiopaque calculi are identified.



Submandibular glands: The submandibular glands have a normal size and enhancement

pattern. No submandibular gland masses or ductal dilatation is seen. No radiopaque calculi

are identified.



Thyroid gland: The thyroid gland is normal in size. There are no thyroid nodules.



Thoracic inlet: Normal.



Lung apices: Normal.



Brain: Limited evaluation of the brain parenchyma does not demonstrate any mass, mass

effect, edema, hemorrhage or infarct.



Orbits: No orbital masses are seen. The globes, extraocular muscles and lacrimal glands

are normal.



Paranasal sinuses: Normally developed and aerated.



Temporal bones: Normal.



Cervical and upper thoracic spine: Normal.



IMPRESSION:



Pathologically enlarged right level III and right level IV lymph nodes. Histologic

sampling is recommended if they need to be further characterized.



No primary aerodigestive tract lesion is seen.



Signed by: XXXXXXX Panasci MD

Signed Date: 10/6/2020 3:21 PM EDT
doctor
Answered by Dr. Indranil Ghosh (3 hours later)
Brief Answer:
Suspicion for cancer is there

Detailed Answer:
Hi
Thanks for your query.

This CT report corroborates the size of level IV lymph node on rt side which is 3.4 cm. This is definitely significant. In addition, another rt level III LN is there of size 2.3 cm.

So it's not possible to label these as benign without doing a biopsy.

I would strongly recommend doing a biopsy to confirm the diagnosis. Just on the basis of CT report we won't be able to confirm or refute a diagnosis of cancer.

Hope this helps.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Indranil Ghosh (0 minute later)
Brief Answer:
Suspicion for cancer is there

Detailed Answer:
Hi
Thanks for your query.

This CT report corroborates the size of level IV lymph node on rt side which is 3.4 cm. This is definitely significant. In addition, another rt level III LN is there of size 2.3 cm.

So it's not possible to label these as benign without doing a biopsy.

I would strongly recommend doing a biopsy to confirm the diagnosis. Just on the basis of CT report we won't be able to confirm or refute a diagnosis of cancer.

Hope this helps.
Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Indranil Ghosh (3 hours later)
I have an appointment for a biopsy next week. What I don't understand is why the radiologist who read the Scan didn't state the characteristics of the lymph nodes besides the sizes. My friend had a slightly bigger lymph node than mine and there was more abnormal characteristics besides size stated. For example, it stated the shape of the node. I spoke to the radiologist who read my scan and he said there is no evidence of head or neck cancer and he doesn't think he sees evidence of lymphoma. Also I had blood work done from a hemotologist for other reasons and everything came back normal. I also have a necrotic tooth on the same side as the lymph nodes if that makes a difference. And i had a thyroid ultrasound 5 years ago that found no enlarged lymph nodes in my neck. Where you able to see the blood test I uploaded yesterday? Also I feel perfectly fine. I don't have any of the symptoms of lymphoma and my CBC blood test came back normal. In all your years of experience what are my chances that this is not cancer?
default
Follow up: Dr. Indranil Ghosh (0 minute later)
I have an appointment for a biopsy next week. What I don't understand is why the radiologist who read the Scan didn't state the characteristics of the lymph nodes besides the sizes. My friend had a slightly bigger lymph node than mine and there was more abnormal characteristics besides size stated. For example, it stated the shape of the node. I spoke to the radiologist who read my scan and he said there is no evidence of head or neck cancer and he doesn't think he sees evidence of lymphoma. Also I had blood work done from a hemotologist for other reasons and everything came back normal. I also have a necrotic tooth on the same side as the lymph nodes if that makes a difference. And i had a thyroid ultrasound 5 years ago that found no enlarged lymph nodes in my neck. Where you able to see the blood test I uploaded yesterday? Also I feel perfectly fine. I don't have any of the symptoms of lymphoma and my CBC blood test came back normal. In all your years of experience what are my chances that this is not cancer?
doctor
Answered by Dr. Indranil Ghosh (3 hours later)
Brief Answer:
Some characteristics are mentioned

Detailed Answer:
He mentioned that these are non necrotic nodes and no evidence of spread outside capsule.

Non necrotic nodes are seen in lymphoma or benign disease rather than head and neck cancer. Blood report is negative for any mutation but lymphoma won't show any mutation in blood either.

Sometimes lymphoma, especially low grade doesn't have any symptoms. So we need to a biopsy, as rightly planned. I would say that possibility of lymphoma is there but low. Still needs to be ruled out.

regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Indranil Ghosh (0 minute later)
Brief Answer:
Some characteristics are mentioned

Detailed Answer:
He mentioned that these are non necrotic nodes and no evidence of spread outside capsule.

Non necrotic nodes are seen in lymphoma or benign disease rather than head and neck cancer. Blood report is negative for any mutation but lymphoma won't show any mutation in blood either.

Sometimes lymphoma, especially low grade doesn't have any symptoms. So we need to a biopsy, as rightly planned. I would say that possibility of lymphoma is there but low. Still needs to be ruled out.

regards
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Indranil Ghosh

Oncologist

Practicing since :2004

Answered : 1712 Questions

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I Would Like To Have AHemotologist Explain This Report To

I would like to have aHemotologist explain this report to me and let me know if it could be cancer. Report CT-SOFT TISSUE NECK POST IV CONTRAST History: Right-sided neck mass/swelling. Recent ultrasound reportedly demonstrated a right level IV lymph node measuring 3.2 cm Technique: The patient was examined and a marker placed over the area of clinical concern. Following the administration of 85cc of Omnipaque 350 intravenous contrast axial images were obtained through the neck with sagittal, axial and coronal reformatted images then generated from the axial acquired data. This study was performed using automatic exposure control (radiation dose reduction software) to obtain a diagnostic image quality scan with patient dose as low as reasonably achievable. One or more of the following dose reduction techniques were used: Automated exposure control, Adjustment of the mA and/or kV according to patient size or Use of iterative reconstruction technique. The administered radiation dose was 1.9 mSv. Renal function: Per ACR guidelines and Zwanger-Pesiri policy, a creatinine level was performed prior to the examination. Results were as follows: Creatinine = 0.4 mg/dL. Prior examinations: Ultrasound dated September 7, 2020. Aerodigestive tract: No primary aerodigestive tract lesion is seen. Lymph nodes: No pathologically enlarged lymph nodes are seen at the following locations: -Right level III measuring 2.3 cm in craniocaudad dimension, 9 mm left-right dimension and 5.5 mm anterior-posterior dimension (see axial image #61 of series #7 and sagittal image #46 of series #4). -Right level IV lymph node that measures 3.4 cm in craniocaudad dimension, 1.7 cm anterior-posterior-posterior dimension of 5.8 mm in left-right dimension (see sagittal image #47 of series #4, axial image #309 of series #6 and coronal image #43 of series #3. Multiple other lymph nodes are seen in the neck which are all less than 1 cm in diameter. All lymph nodes are solid without necrosis or extracapsular spread of disease. Parotid glands: The parotid glands have a normal size and enhancement pattern. No parotid masses or ductal dilatation is seen. No radiopaque calculi are identified. Submandibular glands: The submandibular glands have a normal size and enhancement pattern. No submandibular gland masses or ductal dilatation is seen. No radiopaque calculi are identified. Thyroid gland: The thyroid gland is normal in size. There are no thyroid nodules. Thoracic inlet: Normal. Lung apices: Normal. Brain: Limited evaluation of the brain parenchyma does not demonstrate any mass, mass effect, edema, hemorrhage or infarct. Orbits: No orbital masses are seen. The globes, extraocular muscles and lacrimal glands are normal. Paranasal sinuses: Normally developed and aerated. Temporal bones: Normal. Cervical and upper thoracic spine: Normal. IMPRESSION: Pathologically enlarged right level III and right level IV lymph nodes. Histologic sampling is recommended if they need to be further characterized. No primary aerodigestive tract lesion is seen. Signed by: XXXXXXX Panasci MD Signed Date: 10/6/2020 3:21 PM EDT