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Having night sweats, mid scapula pain and chest pain. Scan showed lymph node in chest. Tumor?

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Dr. Gyanshankar Mishra

Pulmonologist

Practicing since :2003

Answered : 600 Questions

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Posted on Mon, 7 Jan 2013 in Cancer
Question: Hello. I am a 42 year old non smoker. I have had right sided, mid scapula pain for about 3 months that will radiate to my chest. The pain did not respond to chiropractic care, physical therapy and mutiple trials of muscle relaxants. This pain only occurs with sleeping and will wake me nightly. I also have had night sweats off and on. I recently had an MRI to evaluate the pain and a 5cm spot was found in my upper right lobe. I followed up with a CT scan that confirmed this spot, as well as some lymph nodes in my chest and a "non specific" finding on my liver. My WBC were slightly elevated (I don't know the exact value) but LFT's and chemistry labs were normal. I recently had a cold over Thanksgiving with one day of fever and some cough/cold syptoms for 5 days. Symptoms were for the most part resolved at the time of the radiology studies. I was placed on antibiotics and checked for TB as I am a health care worker. TB was ruled out. The plan of care is to check a chest xray at the completion of 10 day course of levequin and repeat the CT in one month. If no improvent in the lung or lymph nodes we will talk biopsy at that time. Do these findings sound consistant with infection vs tumor, and could waiting a month for further evaluation be detrimental if this is determined not to be infection? Any information would be greatly appreciated.
doctor
Answered by Dr. Gyanshankar Mishra 37 minutes later
Hi,
Thanks for posting the query on XXXXXXX
After going through your query, I would like to comment the following:

1. You seem to have been diagnosed with asthma, hypothyroidism and eczema along with right upper lobe 5 cm lesion at present.There is also mediastinal adenopathy along with some liver lesion.

2. A repeat xray after 2 weeks of antibiotic course is an acceptable line of management.

3. If at 2 weeks there is no sign of any radiological resolution then a ct guided fnac or biopsy can be done. If resolution is present then infective etiology should be suspected else further work up needs to be done.

4. Bronchoscopy can be done at this stage however , you being asthmatic some risk will be involved.

5. Also a full clinical check for any evidence of lymph node if present needs to be done.

6. Serum IgE levels need to be checked and if raised the IgE specific for aspergillus fumigatus needs to be done.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Gyanshankar Mishra 6 hours later
I'm sorry. I do not feel my questions were answered. I am trying to find out if my symptoms are more consistent with infection or tumor. Also, if this turns out to be some sort of tumor am I at risk of a poorer prognossis by waiting 1 month to repeat a CT scan? There is no plan to do any type of biopsy until results of that CT are received.
doctor
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi,
Thanks for the follow up query and info.

1. Your complaints are of chest pain since 3 months and cough/ cold since 5 days.Associated complaints include night sweats. Did you have early morning mild cough since the last 2 to 3 months?

2. I am presuming the patch on xray to be a consolidation.

3. In such cases, it is not possible to pinpoint a diagnosis before investigations.

4. Only a clinical trial of 2 weeks of antibiotics will help us guide towards the etiology.

5. The exact ct report and the description liver lesions on sonography are not mentioned.

6. There are many causes of non resolving consolidation apart from malignancy. Only fnac/ biopsy will confirm the diagnosis.

7. Pain more than other symptoms may be found in malignancy but please do not rush to the conclusion as infection is always first on the differential diagnosis list and only after ruling out infections and other causes can we rush towards malignancy. Your ct report has not mentioned any other findings.

8. If detailed reports of ct , usg and xray are made available to me I will be able to give a more detailed info.

9. Thus think of infective causes first but we can not rule out malignancy at this stage as it is a possibility.

10. Your doctor must have interpreted the findings not suggestive of malignant lesion at present hence advised for a trial of antibiotic.

11. If the reports have any sign of malignancy then fnac / biopsy should be done at the earliest but in absence of such findings a 2 week period is acceptable (at least for repeat xray). 1 month seems to be a bit more for re evaluation.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Gyanshankar Mishra 8 days later
After 10 day course of levaquin I had a chest xray that showed an increase in the 5cm lesion, and an additional 4 cm lesion. Clinically I have an occasional cough which at times is productive. I have not run fever and have been feeling well. Would this finding be more consistent with infection or tumor?
doctor
Answered by Dr. Gyanshankar Mishra 4 hours later
Hi,
Thanks for the follow up info.
I would suggest that you get a ct guided fnac from the thoracic lesion at the earliest.
Possibility of tumor cannot be ruled out and you should not take this lightly. Absence of fever makes the chance of typical infection less likely but it could still be atypical infection.

Thus chances non infective condition (malignancy is one of them) is more likely than infective condition at this stage.

I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.

Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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