
Having Night Sweats, Mid Scapula Pain And Chest Pain. Scan Showed Lymph Node In Chest. Tumor?

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After going through your query, I would like to comment the following:
1. You seem to have been diagnosed with asthma, hypothyroidism and eczema along with right upper lobe 5 cm lesion at present.There is also mediastinal adenopathy along with some liver lesion.
2. A repeat xray after 2 weeks of antibiotic course is an acceptable line of management.
3. If at 2 weeks there is no sign of any radiological resolution then a ct guided fnac or biopsy can be done. If resolution is present then infective etiology should be suspected else further work up needs to be done.
4. Bronchoscopy can be done at this stage however , you being asthmatic some risk will be involved.
5. Also a full clinical check for any evidence of lymph node if present needs to be done.
6. Serum IgE levels need to be checked and if raised the IgE specific for aspergillus fumigatus needs to be done.
I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist


Thanks for the follow up query and info.
1. Your complaints are of chest pain since 3 months and cough/ cold since 5 days.Associated complaints include night sweats. Did you have early morning mild cough since the last 2 to 3 months?
2. I am presuming the patch on xray to be a consolidation.
3. In such cases, it is not possible to pinpoint a diagnosis before investigations.
4. Only a clinical trial of 2 weeks of antibiotics will help us guide towards the etiology.
5. The exact ct report and the description liver lesions on sonography are not mentioned.
6. There are many causes of non resolving consolidation apart from malignancy. Only fnac/ biopsy will confirm the diagnosis.
7. Pain more than other symptoms may be found in malignancy but please do not rush to the conclusion as infection is always first on the differential diagnosis list and only after ruling out infections and other causes can we rush towards malignancy. Your ct report has not mentioned any other findings.
8. If detailed reports of ct , usg and xray are made available to me I will be able to give a more detailed info.
9. Thus think of infective causes first but we can not rule out malignancy at this stage as it is a possibility.
10. Your doctor must have interpreted the findings not suggestive of malignant lesion at present hence advised for a trial of antibiotic.
11. If the reports have any sign of malignancy then fnac / biopsy should be done at the earliest but in absence of such findings a 2 week period is acceptable (at least for repeat xray). 1 month seems to be a bit more for re evaluation.
I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist


Thanks for the follow up info.
I would suggest that you get a ct guided fnac from the thoracic lesion at the earliest.
Possibility of tumor cannot be ruled out and you should not take this lightly. Absence of fever makes the chance of typical infection less likely but it could still be atypical infection.
Thus chances non infective condition (malignancy is one of them) is more likely than infective condition at this stage.
I hope I have answered your query. I will be glad to answer follow up queries if any.
Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist

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