What Do The Following Test Reports Indicate?
I would like to consult with a Radiologist to review some MRI, CT, and X-Ray images, if possible. Below I have listed the relevant Pairs of studies with Online Viewing links. Please let me know if I can get a reading and evaluation of these scans. I would really appreciate if you can use the older scan as a reference for the more recent one.
Relevant Symptom History: Shortness of breath, Coughing, Nail Clubbing for 2.5 months
If possible, please try to view all of them at the following link ==> https://goo.gl/m0gEWj
If that is not possible, I have uploaded the GGO region of CT Chest w/ Contrast. I really hope you can access the link, because that contains full, complete studies. I cannot upload such large-size full studies on the attachment sidebar.
 Chest CTs:
>(12/22/16) CT Chest With Contrast
>(12/02/16) HRCT Chest WithOut Contrast
 Neck Scans:
>(12/22/16) CT Neck With Contrast
>(12/22/16) MRI Neck With and Without Contrast
>(11/05/16) MRI Neck With and Without Contrast
Mainly I am concerned about malignant process, particularly lung cancer
1) The original radiologist had seen a geographic ground glass opacity on the Chest CT w/ Contrast. I am wondering about the following likely malignant characteristics..
This is a study I had seen on malignant vs. benign GGOs, from Pubmed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/
They had concluded that: "In conclusion, an fGGO nodule with lobulation, a well-defined but coarse interface and pleural indentation gives a greater than average likelihood of being malignant."
They also mentioned "bubble lucency" and "spiculated border."
Can you please tell me if the GGO I have contains any malignant characteristics (lobulation, well-defined but coarse interface, pleural indentation, bubble lucency, spiculation)?
2) As for the Neck Scans. The original radiologist had reported some lymph nodes and "ill-defined soft tissue stranding"
I am worried most about the left supraclavicular "Virchow" node which I have felt was quite firm since October 2016, but doctors have not said it was large enough to FNAC.
--Is it true that it is not big enough for even FNAC? Or is FNAC possible on this supraclavicular node?
--Any other nodes that have dimension sufficient for FNAC at least?
--Also, what causes the soft tissue stranding? Could be malignant process?
-Thank you doctor!
The ground glass opacity seems to be due to artefacts
Thanks for writing in to us.
The ground glass visualised is not the real ground glass because the HRCT sections do not show it. However, continuing with the discussion of ground glass opacities, I do not find any areas which are suspicious for malignancy based on the lung findings.
There are hundreds of lymph nodes in the head and neck region and usually remain small. When there is any disease condition then it gets enlarged. The enlargement is due to triggering of the immune system. This causes a small local reaction which leads to soft tissue stranding.
In the light of above findings, it would help to discuss with your doctor if they can recommend a PET CT scan which will show any such suspicious areas of aggressive lymph node enlargement.
Please do write back if you have any doubts.
-Just making sure, were you able to access the above link to the full set of Radiology Images?
If not, I have uploaded a PDF document "Radiology_Links.pdf" with a set of links to radiology studies. Please let me know if you can access those links within that document and review them for a more complete assessment.
--For the ground glass opacity, what do you mean by "not real ground glass"?
--As for the soft tissue stranding, so you mean to say that past infection etc. could have caused lymph nodes to enlarge and cause soft tissue stranding?
Ground glass is probably due to the techniques used
Thanks for writing back with an update.
I have seen each set of pictures and feel that the ground glass was due to the techniques used. It is not visualized on HRCT and therefore I feel it is something which is not a serious finding.
Yes you are right, any small infection or inflammation can cause fat stranding. It shows the reaction of surrounding soft tissues to the mild inflammation which took place.
Just to clarify, the HRCT Noncontrast was done a few weeks prior to the CT Contrast.
--What exactly was the difference in techniques used per each test date?
--So you are saying that the difference in findings is more likely due to technique as opposed to something that developed between the timeframe of the two exams?
--Does Noncontrast HRCT usually visualize ground glass opacities?
Unusual to have ground glass opacities in interval period
Thanks for writing back with an update.
HRCT is a technique to look for diffuse lung diseases. It images the lung in 1 mm sections with intervals of 10 mm in most cases. Therefore it has increased image nose. It is better suited for study of lung lobules and septae.
The contrast chest CT is a general assessment of the lungs with thicker sections.
Non contrast HRCT is useful in detecting ground glass opacities.
It is rare to have ground glass opacities appear in the interval phase between scans separated in few weeks.