Get your health question answered instantly from our pool of 18000+ doctors from over 80 specialties

153 Doctors Online
Doctor Image
Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

What does this CT scan report indicate?

Answered by
Dr. Jnikolla


Practicing since :2003

Answered : 1608 Questions

Posted on Wed, 9 May 2018 in Lung and Chest disorders
Question: Hi,

Initially I had some right sided chest pain which I suspected was related to GERD and wanted to investigate further without doing a gastroscopy.

I was advised for a CT and the report result reads:

There is a cluster of ill-defined nodules in the apical segment of the left lower lobe. There is no evidence of cavitation or calcification. The rest of the lungs are clear. There is no pulmonary consolidation, pneumothorax or pleural effusion.

The airways are patent. Incidental note of the posterior segmental bronchus of the right upper lobe, arising directly from right bronchus intermedius.

There is no mediastinal, hilar or axillary lymphadenopathy. The heart size is within normal limits. There is no pericardial effusion. The visualised upper abdomen is unremarkable.

No rib fracture, rib lesion or chest wall abnormality is detected. No significant bony abnormality is detected.


The cluster of ill-defined modules in the apical segment of the left upper lobe is likely inflammatory/infectious. Specifically, TB should be considered.
There is no cavitation or lymphadenopathy.

I had a sore throat roughly a week before doing this CT with low grade fever but initially no sputum production. However, there was sputum produced on the day of this CT scan but previously there was basically none.

I have done some initial tests on sputum for TB. The results were as follows:

28th Nov
Direct smear AFB (ZN Stain)
No Acid-fast bacilli seen

Gram Stain
Pus cells (+++)
Epithelial cells (few)
Gram positive rods (+)

Culture lower respiratory
No growth of pathogen

29th Nov
Smear Acid Fast Bacilli, No AFB seen

Culture, sputum final, No growth of pathogen

Gram Stain Final
White blood cells, Seen (3+)
Epithelial cells, Seen (few)
Gram positive cocci, Seen (1+)

30th Nov
TB Probetec
M. Tuberculosis complex DNA not detected
Nucleic acid amplification test results are preliminary, pending culture results.

METHOD: Strand displacement amplification (ProbeTec DTB Assay)

A negative result does not exclude the possibility of low concentration of MTBC DNA, or MTBC variants that lack the IS6110 gene.

Performance data for smear-negative respiratory (n=83) and non-respiratory (n=422) samples

Respiratory specimens Non-respiratory specimens
ST 14/15 93.3% 31/31 100.0%
SP 68/68 100.0% 389/391 99.5%
PPV 14/14 100.0% 31/34 91.2%
NPV 68/69 98.6% 388/388 100.0%

Performance data for smear-positive (respiratory and non-respiratory) samples (n=55)

ST 46/46 100.0% PPV 46/46 100.0%
SP 9/9 100.0% NPV 9/9 100.0%

Please correlate this result with clinical, radiological and other laboratory findings.

Are there other tests that can be recommended for TB or should these tests be enough? Should I expect further culture results or do these culture results appear final?

Why is the quantiferon Gold test considered of limited value in many parts of the world? Should I have this test?

What could be other causes of the CT scan findings?


Answered by Dr. Jnikolla 41 minutes later
Brief Answer:
Probably PPD skin test

Detailed Answer:
Hello and thank you for asking in HCM

I can understand your concern

As you explain the history the fact that the direct smear AFB (ZN Stain) is negative means that in your organism there are not bacilli of tuberculosis in active status. However the culture of the secretions is the best examination for excluding completely it (which needs 4-6 weeks for the result). M. Tuberculosis complex DNA test - negative is although a good sign that relates with the above.

If you were my patient i would first recommend you to do a simple PPD skin test. If this test is negative then no another test for tb is needed to do further . If positive than direct smear AFB (ZN Stain) and DNA test are indicated (you have already done them).

I do not recommend Quantiferon B for you. It is mainly for latent TB and in your case it would be negative too (good sign).It is considered of limited value in many parts of the world especially in countries with high incidence and prevalence of TB.

Other causes of the CT scan findings might be other non tuberculous mycobacteria infection of the lungs.

According to the history you provide it might be a past infection which had left a sign in your lungs but no need to worry about.

Please discuss with your doctor for the above

Regards and feel free to ask me again


Above answer was peer-reviewed by : Dr. Vaishalee Punj
Follow up: Dr. Jnikolla 53 minutes later
Thanks Dr. Jolanda,

I will consider the simple skin test perhaps as further confirmation. Could you explain why the Quantiferon B test is of limited value in the cases of high incidence of TB? Can it distinguish between active and latent infection?

What sort of other tests can be done to find whether other mycobacteria are infecting the lungs currently? Would the culture of sputum or gram stain normally pick these up and should I also wait a few weeks to see the final culture results to find out if there are other bacteria in the lungs? Or do the culture tests normally specifically only try to culture one type of bacteria?

Answered by Dr. Jnikolla 1 hour later
Brief Answer:
continue discussion

Detailed Answer:
Hi again

Quantiferon test is of limited value in countries with high incidence of tb because subjects in there have already high possibility to have encountered bacillus of tb during their lifetime.
It distinguishes the activation of latent tuberculosis in patients who have had tb before.

I suggest you to wait till the culture result which in se might have seen if there are different mycobacteria from tb ones.

Hope to have been helpful



Above answer was peer-reviewed by : Dr. Prasad

The User accepted the expert's answer

Share on
Question is related to
Diseases and Conditions ,   ,   ,   ,  
Lab Tests
Medical Topics ,  

Recent questions on  Axillary lymphadenopathy

doctor1 MD

Since 10 - 20 years pain on both breasts. Age: 35, W:50,H:5.3ft, ULTRA SOUND ON BOTH BREASTS were done using 7.5 Mhz high frequency linear probe. Right Breasts: Multiple (6-8 in number) well defines cysts of varying sizes is noted diffusely distributed in breast parenchyma largest of 5*3 mm in 4 O clock in zone 3. Nipple and areolar region appears normal. Retromammary space is clear. No axillary lymphadenopathy noted. LEFT BREASTS: Multiple (4-6 in number) well defined cysts of varying sizes is noted diffusely distributed in breast parenchyma largest of 10*5 mm in 3 O clock position in zone 3. Well defined hypoechoic lesion with longitudinal orientaation noted in 4 O clock position. No cystic areas / vascularity noted on doppler. Nipple and rest of the areolar region appears normal. Subareolar region is normal. Retromammary space is clear. Solitary benign appearing axillary lymphnode noted measuring 8*6 mm. PLEASE KINDLY ADVISE THE TREATMENT!!!!! URGENT!!!!!

doctor1 MD

yes. i recently began having a burning sensation in and around my axillary lymph nodes on both sides of my chest. they hurt when i run and when i bend forward and reach with either arm. i recently began doing more aerobics but i was wondering if it has anything to do with my water intake. i try to stay hydrated daily.

doctor1 MD

I am 33 years old, I was diagnosed with pneumonia almost a month ago after a short period of low grade fever and dry cough. Even after treatment with 4 courses of antibiotics dry cough has not resolved.I am having pain on the right lower side of the rib which is constant and experiencing back pain and pains all over my back and chest in a nonspecific pattern. A chest CT was performed and found subsegmental consolidatory changes in the anterior and lateral basal segments of right lower lobe with bronchial wall thickening, minimal ground glass opacification in the adjacent posterior and medial basal segments, few small mediastinal and axillary lymph nodes, plus few lymph nodes seen in the pretracheal region, few of them showing dense calcification.

My last lab report from december 23rd is as follows
TOTAL COUNT-7200/cumm
Neutrophils-70%, Lymphocytes-28%, Eosinophils-2%
ESR-28 mm/hr.
Still I am having fatigue, dry cough and pains. What can it be?

doctor1 MD

Name-Mrs. XXXXXXX XXXX, age-46 yrs, Height-4'10", weight-65 kg, Dr sir, My wife has been suffering a mild pain in upper left breast just near left armpit for 1 months. USG report is given below..... All the four quadrants of left breast including...

doctor1 MD


My wife is 52 years old. Of late she has been diagnosed with moderately Differentiated Ductal Carcinoma in my left breast through FNAC on 21.12.2013

Prior to FNAC she has undergone Bilateral Mammogram and Ultra Sonography of Breast on 17.12.2013.
The finding of the Tests is given here under.
Bilateral Mammogram:
Right Breast: Fibroglandular breast tissues show heterogeneous Nodular pattern. Fibroadenoma with supero- medial aspect BI -RADS - 2 .
Left Breast Fibroglandular breast tissues show heterogeneous Nodular pattern.
One Nodular density (1.8*2.3) is seen in infero- medial aspect without any microcalcification inside.nature- indeterminate BI- RADS-4B
Axillary lymph node is seen on left side.
Skin and nipple outlines on both sides are normal.


Right Breast: A nodule with posterior acoustic shadowing is noted in right Breast in upper middle quadrant.Parenchymal echopattern of right breast otherwise appears to be within normal limits.

Left Breast: A lobulated hypoechoic SOL measuring1.4*1.3*1.3 cm in size is noted in lower medial quadrent.
Both axllae- No enlarged lymph Node seen.
Impression: SOL in lower medial quadrent of left breast-? Fibroadenoma.
Involuting fibroadenoma in upper middle quadrent of right breast.


Smear show scattered as well as in groups pleomorphic epithelial cells.
The cells have coarse chromatin,prominent nucleoli and variable amount of cytoplasm.
Diagnosis: Moderately Differenciated Ductal Carcinoma.

Followed by such report consultation has been made with an oncology surgeon. He advised the following tests for next course of treatment.

1)     Complete Blood test including LFT,CA-15.3,
2)     Whole body bone scan
3)     Ultrasound of whole abdomen
4)     Chest x ray PA view
5)     Electrocardiogram

Report of the above tests has indicated within normal range.

Finally she has undergone Breast Conservation Surgery on 13.01.2014.

Histo pathology reports is as under:-

1) Invasive ductal carcinoma of breast-grade-lll
2) Surgical cut margins and deep plane of resection-free of lesion
3) Axillary lymph nodes-reactive. No Metastasis.
4) No definite lymphovascular or perineural invasion found.

ER, PR&Her-2/neu report is as under: -

ER- Negative

PR- Negative

C erb B2 – Negative

The Mib-1(Ki-67)labeling Index is approximately 60-70%.

This is in nutshell the present status of disease of my wife.
Kindly favor me with your advice as regards her next management of treatment as well as her survival possibility.


Snehanshu kar chaudhuri

doctor1 MD

Having sharp pain in left arm pit. No swelling or redness. No chest pain . Pain very intermittent. No injury associated with pain. In the past I've cortisone injections for shoulder pain; haven't had any for several years. Possible causes?