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What Does "Multiple Unenhanced Axial Cuts Obtained Through The Chest" Mean?
Question: I talked with Dr. Kaushl Bhavsar Sept 15 2014 online concerning a single pulmonary nodule in husbands chest, he has since had a ling /chest Ct to look for more noduels as the first one was found on abdominal CT incidentally and the CT went no higher than the very low lung area. We have since had the follow up CT of entire chest/lungs. We would like advice and second opinion. My husband has displayed some shortness of breath that my grown daughter and myself noted and remarked to him on a couple of occasions and he has had steady chest discomfort/no pain for months now on left upper chest and complains of being concerned of it though he has no pain there he says it feels wrong and he can feel something there and is not quite a pressure and can’t describe it. He is a very non complaining man by nature. Only miss one day of work in 30 years. Ct was done of abdomen as he has positive Fecal occult blood tests and anemia with all “scopy” work negative on colon and stomach etc. Lung nodule finding was per chance. I quest to find what is causing mild anemia and fecal positive for blood.
Age 52yrs weight 218 lb height 6 ft no illness no allergy no medical history other than two benighn stomach polyps in 2005 removed. And repeated low anemia and pos FOBT. Several colonoscopies all neg. as well as endoscope neg. celiac neg. non smoker non alcohol drinker healthy life style.
CT 9/23/2014
Findings: Multiple unenhanced axial cuts obtained through the chest.
The left lung is clear.
No nodule or pulmonary infiltrate.
On the right, there are multiple small nodules that include a peripheral 4 mm nodule of the posterior basilar segment of the vague increased density as well as two more superior loosely clustered nodules of the superior segment of the right lower lobe largest measuring 1.5 cm with a second 7 mm nodule lying just anterior. The larger 1.5 cm nodule displays a small central high density suggesting developing calcium. There are multiple small-calcified right hilar nodes/ This is suggestive of an inflammatory likely granulomatous process. This does require close follow-up however I would recommend repeat examination in a 4-6 month period pet CT to begin a 2 – year surveillance of these nonspecific nodules.
Detail of hila and mediastinum limited given lack of IV contrast. No mediastinal mass observed.
Attached screen shots of CT .
Many thanks for your help,
XXXXXXX XXXXXXX
Age 52yrs weight 218 lb height 6 ft no illness no allergy no medical history other than two benighn stomach polyps in 2005 removed. And repeated low anemia and pos FOBT. Several colonoscopies all neg. as well as endoscope neg. celiac neg. non smoker non alcohol drinker healthy life style.
CT 9/23/2014
Findings: Multiple unenhanced axial cuts obtained through the chest.
The left lung is clear.
No nodule or pulmonary infiltrate.
On the right, there are multiple small nodules that include a peripheral 4 mm nodule of the posterior basilar segment of the vague increased density as well as two more superior loosely clustered nodules of the superior segment of the right lower lobe largest measuring 1.5 cm with a second 7 mm nodule lying just anterior. The larger 1.5 cm nodule displays a small central high density suggesting developing calcium. There are multiple small-calcified right hilar nodes/ This is suggestive of an inflammatory likely granulomatous process. This does require close follow-up however I would recommend repeat examination in a 4-6 month period pet CT to begin a 2 – year surveillance of these nonspecific nodules.
Detail of hila and mediastinum limited given lack of IV contrast. No mediastinal mass observed.
Attached screen shots of CT .
Many thanks for your help,
XXXXXXX XXXXXXX
Brief Answer:
I concur with Dr. Kaushal's opinion.explain you in details.
Detailed Answer:
Hi,
I have gone through your question and your reports.
You seem to have mainly two problems, one is nodules in lung and other is anemia. Pulmonary nodule has many causes. Smoking related cancers, adenocarcinoma, granulomatous dieases, tuberculosis are to name a few. I am glad you don't smoke or consume alcohol. Therefore follow up CT scan at 6 months interval seems to be a good plan of action. Alternatively you can go for biopsy of that nodule. Biopsy will give perfect diagnosis.
Your anemia is very surprising. In adults male patients with anemia we have to look for GI bleeding. I would suggest a gastroenterologist consultation. Moreover Crohns disease is also associated with nodule. But as you say you have repeated negative colonoscopy, I feel the it might be less likely.
You should also get peripheral smear examination to look for type of anemia. We might be able to figure some deficiency then you should take treatment accordingly. So go for testing and take treatment accordingly.
Hope I have answered your question, if you have any further questions then feel free to ask me.
I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
I concur with Dr. Kaushal's opinion.explain you in details.
Detailed Answer:
Hi,
I have gone through your question and your reports.
You seem to have mainly two problems, one is nodules in lung and other is anemia. Pulmonary nodule has many causes. Smoking related cancers, adenocarcinoma, granulomatous dieases, tuberculosis are to name a few. I am glad you don't smoke or consume alcohol. Therefore follow up CT scan at 6 months interval seems to be a good plan of action. Alternatively you can go for biopsy of that nodule. Biopsy will give perfect diagnosis.
Your anemia is very surprising. In adults male patients with anemia we have to look for GI bleeding. I would suggest a gastroenterologist consultation. Moreover Crohns disease is also associated with nodule. But as you say you have repeated negative colonoscopy, I feel the it might be less likely.
You should also get peripheral smear examination to look for type of anemia. We might be able to figure some deficiency then you should take treatment accordingly. So go for testing and take treatment accordingly.
Hope I have answered your question, if you have any further questions then feel free to ask me.
I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Prasad
hello
buhut shukriyaa for quick answer.
He has gastroenterologist working up and will do camera pill to look at small bowel.
the blood workup was complete and advanced. he had only the iorn deficient anemia and his doctor says it is most commonly in the gastro-intestinal finding but cant find it. all other blood work was ok.
is blood smear different? and not done with most blood workup?
they said low red blood cells.
I will review this with my husband. Your idea to wait and see and maybe get biopsy. Appreciate your help.
buhut shukriyaa for quick answer.
He has gastroenterologist working up and will do camera pill to look at small bowel.
the blood workup was complete and advanced. he had only the iorn deficient anemia and his doctor says it is most commonly in the gastro-intestinal finding but cant find it. all other blood work was ok.
is blood smear different? and not done with most blood workup?
they said low red blood cells.
I will review this with my husband. Your idea to wait and see and maybe get biopsy. Appreciate your help.
Brief Answer:
If it is proved iron deficiency anemia then ok.
Detailed Answer:
Hi, dear.
I have gone through your question. I can understand your concern.
If it is proved that he has iron deficiency anemia then no need of peripheral smear examination.
Most common cause of iron deficiency anemia is chronic bleeding from gastrointestinal tract.
So search for the cause like peptic ulcer or hemorrhoids. I expect the camera pill (capsule endoscopy) will help us here.
If you don't find any cause in gastrointestinal tract then search for other cause like nutritional deficiency or malabsorption. You can discuss on this topic after the camera pill recording.
Hope I have answered your question, if you have doubt then I will be happy to answer you again.
Thanks for using health care magic.
Wish you a very good health.
If it is proved iron deficiency anemia then ok.
Detailed Answer:
Hi, dear.
I have gone through your question. I can understand your concern.
If it is proved that he has iron deficiency anemia then no need of peripheral smear examination.
Most common cause of iron deficiency anemia is chronic bleeding from gastrointestinal tract.
So search for the cause like peptic ulcer or hemorrhoids. I expect the camera pill (capsule endoscopy) will help us here.
If you don't find any cause in gastrointestinal tract then search for other cause like nutritional deficiency or malabsorption. You can discuss on this topic after the camera pill recording.
Hope I have answered your question, if you have doubt then I will be happy to answer you again.
Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Prasad
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