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Underwent left radical nephrectomy. Done with chest x-ray, sonography. ECG normal. Reason for left chest pain?

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I underwent left radical nephrectomy on 12 July 2011. Hence, have been undergoing tests every quarter (chest x-ray, sonography, RFT, LFT, CBC etc).

I am yet to go through my abdomen sonography (last was in Jan'13). Until XXXXXXX 2013, sonography reports were okay (except gall bladder polyps < 5 mm). I would taking one today or tomorrow my regular follow up.

Of late, I have also been feeling mild pain on my left chest but close to the center of the chest. I am seeing a Cardiologist for that. ECG was normal. The Dr suspects acidity. I have to undergo a stress test.

That's for the back-ground.

The point is that for the first time the comments on the chest x-ray states, "Osteolysis noted in left third rib and advised further evaluation" (It also states that lungs, pleura, heart and aorta are normal). I have also mentioned details of my Chest CT Scan report of Oct'12.

What does the latest chest x-ray report mean to me from cancer perspective?

In October 2012, my CT scan of chest (plain) stated the below:

- Minimal fibrotic stranding is noted in the right middle lobe.
- Subtle subpleural septal thickening is noted in the posterior basal segments of both lower lobes, persistent on prone images.
- Rest of the bilateral lungs parenchyma appear normal.
- The trachea and the mainstem bronchi are well seen on both sides and are normal in outlines.
- No significant mediastinal lymphadenopathy is noted.
- The cardiac size appears grossly normal.
- There is no pleural collection seen.
-Bony outgrowth is noted arising from the superolateral margine of anterior aspect of left 1st rib. It measures approx. 1.7 x 3.4 cm and appears continuous with the cortex and medulla of the rib. It indents the overlying pectoralis muscles.

- Visualized superior aspects of liver show no significant abnormality of noted. Post operative changes noted in left renal fossa with radiodense surgical clips. Tiny radiodense gall bladder calculus is also noted.

- Minimal fibrotic stranding in the right middle lobe. Subtle subpleural septal thickening in the posterior basal segments of both lower lobes as described.
- Bony outgrowth arising from the anterior aspect of left 1st rib is suggestive of osteochondroma.
- Post operative changes in left renal fossa with radiodense surgical clips. Tiny radiodense gall bladder calculus is also noted.

-- End of Report --
Posted Fri, 24 May 2013 in Digestion and Bowels
Answered by Dr. Poorna Chandra K.S 1 hour later
Hi XXXXXXX and thanks for the query
Osteolysis means rerefaction of the bone.
This may be generalised in cades of calcium or vit D3 defeciency and in cases of excess parathyroid harmone
It can be a localised phenomenon in case of local pathologies like an expanded bone marrow, presence of a focal excess of plasma cells and also due to a cancer deposits
However cancer deposits secondary to a kidney cancer could be osteolytic as well as osteoblastic (dense bones)
X rays are only for sceening purpose and it has to be further evaluated by either a CT scan or a bone scan.
The Left chest pain seems to correlate with the xray findings. Hence discuss with your doctor and plan further evaluation.
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