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Done chest x-ray due to bronchitis like symptoms. Result shows mediastinal and left hilar adenopathy. Meaning?

Hello. I d really like to have a radiologist s report de-coded . Please help! I can t help but worry and the little bit I am deciphering from this report gives me the impression that it could be a NUMBER of things ranging from no big deal to possibly lung cancer . I m 35 and do not smoke- no history of smoking- no history of lung cancer in the family that I know of. I am being referred to a pulmonologist but meanwhile I d like to have some peace of mind- or at least some empowerment through knowledge instead of sitting and wondering which scenario it could be. This was kind of a freak thing- I went to an urgent care center because of bronchitis like symptoms and the NP told me one lung sounded worse than the other and ordered a chest x-ray which revealed an abnormality. My Dr. sent me for a follow up CT scan and just told me the results were abnormal and told me to see a pulmonoligist. Here s the report from the radiologist: This was a Chest CT scan without contrast. Findings: Evaluation of hilar sctructures is limited due to lack if IV contrast. Pathologically enlarged left hilar lymph node located anterior to the pulmonary artery and vein measureing 2.65 x 2.1 cm likely accounts for the density seen on the recen chest radiograph . Extensive enlarged mediastinal lymph nodes are present. Index nodes include: Right mid paratracheal 2.0 x 1.5 cm, aggregate Ap window 4.6 x 2.8 cm, precarinal 1.5 cm short axis. Subcarinal and azygoesophageal recess and right hilar adenopathy is densely calcified. Right upper paratracheal lymph node within the superior mediastinum measures 1.9 by 1.7 cm. No axillary or supraclavicular adenopathy is seen. A ground-glass nodular density is present within the right upper lobe measuring 6mm. No additional pulmonary nodules are seen. There is no pericardial effusion or pleural effusion . Punctate nonobstructing calculus is seen within the right upper renal pole. There are no acute or suspicious osseous abnormalities. Impression: 1) Mediastinal and left hilar adenopathy as described in detail in the report. Both benign and malignant etiology should be considered. Of note, calcified lymph nodes within the subcarinal and azygoesophageal recess and right hilum raise the possibility of granulomatous disease changes, such as sarcoidosis. Correlate with patient s known clinical history. 2) 6mm ground-glass nodular density the right upper lobe. This is nonsepcific. It could represent infectious - inflammatory nodule or even focal area of fibrosis. It should be recognized that occasionally bronchoalvelar cell carcinoma can present similarity. However, given the patient s age, this is thought much less likely. Consider CT chest followup in 6 months. 3) Tiny nonobstructing right renal calculus.
Asked On : Sun, 3 Mar 2013
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Critical Care Specialist 's  Response
Dear patient ,the causes of mediastinal and hilar lymphadenopathy include, tuberclosis, lymphoma and leukaemias, bronchogenic carcinoma, sarcoidosis, fungal infections like histoplasmosis and coccidiadomycosis and cystic fibrosis. You are absolutly right in saying that it could range from no big deal to any serious condition, therefore it is better to settle down this issue as early as possible by proper further evalvation which will require you to seek a pulmonologists consultation who will advise you some more tests like
transbronchial biopsy of the mediastinal lymphnodes, sputum for AFB, haemogram with general blood picture, CT abdomen or USG abdomen to look for peritoneal and retroperitoneal lymphadenopathy and hepatospleenomegaly, serum calcium level, serum ACE level, LFT and RFT etc and once the diagnosis is confirmed ,your treatement will be planned accordingly
Answered: Sun, 3 Mar 2013
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