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What does my CT scan test report indicate?

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Posted on Tue, 17 May 2016
Question: Morning, afternoon and evening episodes of fever with pain in abdomen since a month. Serology normal, LFT, RFT, Urine routine, Xray chest, usg abdomen normal. blood culture -ve, ESR reduced from 110 to 75 but yet high. Fever not responding to Pipzo.
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Answered by Dr. Tushar Kanti Biswas (22 minutes later)
Brief Answer:
Prolonged fever-cause?

Detailed Answer:
Hi,

Thank you for your query. I can understand your concerns.
It seems you are having fever of unknown origin (FUO)as yet. However association of pain abdomen with multiple episodes of fever in a day with high ESR 75 mm /hour, I suspect possibility of some abdominal cause is more. FUO in XXXXXXX setting in most of the cases boils down to Tuberculosis. TB PCR Gold test will give some lead regarding the same. Did that serology include Brucella agglutination test?

In all cases of FUO, the dictum is to undergo another thorough physical examination particularity for any peripheral lymph node enlargement.
Since chest X-ray is normal, HRCT chest won't be out of place.
In many cases empirical anti-tubercular treatment may be justified.
I recommend you to get the investigations I have mentioned done, so that we may decide further course of action.






Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Sonia Raina
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Follow up: Dr. Tushar Kanti Biswas (2 hours later)
Sir I have uploaded the CT scan of Abdomen and Pelvis. Enlarged Lymphnodes are seen 16mm XXXXXXX size. Today second dose of AKT4. IF Brucella bacteria then it should have responded to Pipzo wright?? Please replay.
doctor
Answered by Dr. Tushar Kanti Biswas (6 hours later)
Brief Answer:
Prolonged fever-cause?

Detailed Answer:
Pipzo a combination of Piperacillin and tazobactum is effective against various gram negative organisms but it is not the drug of choice for Brucelosis.10–20% cases of Brucelosis have significant lymphadenopathy;the differential diagnosis includes Mycobacterium tuberculosis.Brucella agglutination test (agglutinin titers of 1:320–1:640 or higher are considered diagnostic) often provides the only positive laboratory findings in brucellosis.Neither you can diagnose nor you can exclude Brucelosis by trial of antibiotic like Pipzo.

CT scan abdomen and pelvis report has not been uploaded.Does it show any hepatosplenomegaly apart from lymphadenopathy?

Regards

Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by : Dr. Naveen Kumar
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Follow up: Dr. Tushar Kanti Biswas (50 minutes later)
Got it sir. Thank you. I had uploaded sir but website seems to be reluctant. It got uploaded after I refresh i don't find the upload. Apart from it, No hepatosplenomegaly(It would have been clear in sonography??) Nothing but non necrotic enlarged lymphnodes XXXXXXX size 16 mm.
doctor
Answered by Dr. Tushar Kanti Biswas (1 hour later)
Brief Answer:
Prolonged fever-cause?

Detailed Answer:
Abdominal tuberculosis is a possibility.However lymphoma remains differential diagnosis.It would be difficult to get a tissue diagnosis of intra-abdominal lymph node enlargement.Many of these non-necrotic lymph nodes are nothing but reactive lymph nodes.
You need to see the effects of empirical AKT.It should produce result by 3 weeks period.

Regards

Dr. T.K. Biswas M.D. XXXXXXX

Above answer was peer-reviewed by : Dr. Naveen Kumar
doctor
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Follow up: Dr. Tushar Kanti Biswas (2 days later)
Sir, TB PCR Gold(TB Gene Expert) report -ve. Fever on and off. Repeat blood(at time of fever) culture 24 hrs status no growth -ve. Emperical AKT4 day 5. ESR 80. CRP +ve. 2D Echo normal. Further??
doctor
Answered by Dr. Tushar Kanti Biswas (1 hour later)
Brief Answer:
Prolonged fever-cause?

Detailed Answer:
The confirmatory test for tuberculosis would be either biopsy or tissue culture for Mycobacterium tuberculosis. Since none of these is forthcoming,it would be prudent to continue AKT. High ESR and positive CRP indicates chronic inflammation.
Laparoscopic intra-abdominal lymph node biopsy may be required to clinch the exact tissue diagnosis.

Regards

Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Tushar Kanti Biswas

Internal Medicine Specialist

Practicing since :1975

Answered : 1910 Questions

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What does my CT scan test report indicate?

Brief Answer: Prolonged fever-cause? Detailed Answer: Hi, Thank you for your query. I can understand your concerns. It seems you are having fever of unknown origin (FUO)as yet. However association of pain abdomen with multiple episodes of fever in a day with high ESR 75 mm /hour, I suspect possibility of some abdominal cause is more. FUO in XXXXXXX setting in most of the cases boils down to Tuberculosis. TB PCR Gold test will give some lead regarding the same. Did that serology include Brucella agglutination test? In all cases of FUO, the dictum is to undergo another thorough physical examination particularity for any peripheral lymph node enlargement. Since chest X-ray is normal, HRCT chest won't be out of place. In many cases empirical anti-tubercular treatment may be justified. I recommend you to get the investigations I have mentioned done, so that we may decide further course of action. Regards Dr. T.K. Biswas M.D. XXXXXXX