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CT scan showed possible granuloma on spleen and have petechiae on breast. Worrisome

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Allergist and Immunologist
Practicing since : 1999
Answered : 584 Questions
Last month I had a CT scan that showed possible granuloma on my spleen, which is what the doctor thinks it is. The spots are about 1mm in size. The radiologist challenged him to prove it's not early lymphoma. I've had all over itching for 3 years and night sweat on my chest sometimes for 4 years that doctor says is perimenopause. I'm 47 years old. He sent me to an oncologist and she wasn't worried and said we could re-scan in 3 to 6 months. Now I have petechiae on my breast and I'm worried. My CBC was normal. Still really scared and wake up shaking every morning.
Posted Mon, 3 Dec 2012 in Skin Hair and Nails
Answered by Dr. Sujoy Khan 2 hours later

I am sorry to note that you are troubled with your symptoms and your doctors have not come to a diagnosis as yet.

The other tests that I would recommend with the itching and nights sweats (noted that the CBC was normal, and presume that the eosinophil count was also normal), are thyroid functions, mast cell tryptase, lymphocyte subsets for CD4/CD8 (not sensitive enough), bone marrow [invasive and painful test, not usually recommended as 1st line investigations] unless the mast cell tryptase was significantly elevated.

The petechiae if recent onset warrants a repeat of all previous tests. You must also let your doctor know of any recent travel abroad, or for viral serology/PCR as clinically indicated.
FSH, LH levels should be done and if elevated or borderline high will suggest a peri-menopausal state.

Granulomas in spleen are very difficult to confidently diagnose with a CT scan and MRI. PET imaging are more sensitive in knowing what the lesions are.

Immunoglobulin levels IgG, IgA, IgM, with serum electrophoresis must be done to ensure they are normal. Antibody deficiency syndromes and granulomas in spleen will suggest ‘Common Variable Immune Deficiency’ (CVID) like disorder that is quite common in the Western world. An Immunologist should then be involved in further work up and diagnoses/therapy.

I hope that helps.

Please get in touch if you have any queries.

Above answer was peer-reviewed by
Follow-up: CT scan showed possible granuloma on spleen and have petechiae on breast. Worrisome 17 hours later
Would you suggest that I see an Immunologist instead of an oncologist? and a day before I noticed the petechiae on my breasts, I had ridden several roller coasters. Could that cause them? As far as blood work, in the last year I've had lots and lots of tests but cannot tell you about the specific ones you mentioned except thyroid and cbc with differentials. The IgG and IgA sound familiar, so I'm pretty sure they've checked those. My doctor always says that if everyone had blood work like mine he'd be out of business. I have issues with health related OCD (hypochondria) and I'm not sure how far to go with this. My husbands best friend is a GI Dr. and liver researcher in Portland. We sent my results to him which he had his colleges look over. None of them were worried and said if it were them they would either do nothing or maybe another CT in 3 to 6 months. Do you agree with that?
Answered by Dr. Sujoy Khan 12 hours later

Thanks for the follow up.

At present, I don’t think roller coaster rides would be related to the petechiae.

I think a conservative approach of 'watch and wait' is best for now. As your doctor has offered you the CT in 3-6 months, see what new information it provides.

As long as the current information shows that the spleen is not enlarged, antibody (IgG/A/M) levels are normal, with no problems with recurrent infections, as an Immunologist, I will not be too worried for now.

Hope I answered all your questions. Please use any answer clarification before closing and rating this answer. I will be happy to explain or expand on any issue you may have.

Best Wishes.
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