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What Are The Findings From The CT Scan Report?

Posted on Wed, 22 Jan 2014

Question: My mother is having swelling all over the body.CT scan reveals multiple enlarged hypodense lympnodes in RETROPERITONEAL.I am attaching all reports.Please suggest

Answered by Dr. Satyadeo Choubey (1 hour later)

Brief Answer: Anti-tubercular treatment must be started Detailed Answer: Hi, Thanks for your query. Histopathological report of neck node has proved to be tuberculosis. All the CT and sonography significant findings can be explained by this disease like retroperitoneal lymph nodes, ascites, fluid in pouch of dougls etc. But why she has generalised body swelling needs attention. Three common organ system causing this is liver kidney and heart. Hypothyroidism may also cause this, but these three must be ascertained to be normal. So advisable here will be echocardiography (since she is hypertensive too), Liver function test and kidney function test. The later two are blood test and hardly costs 1000 rupees. Patient must be started on anti-tubercular treatment via DOTS (govt. supply) drus or non DOTS. Both are good and drugs are of same company LUPIN. Best wishess

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Satyadeo Choubey (10 minutes later)

Thanks for the Suggestion! She is taking DOTS and her last report for Liver function test and kidney function test found Normal except in Liver Function test Biliribin Direct was 0.4 mg/dL.We will now check echocardiography. She is having excessive swelling from last 2 weeks and she gains around 8 KG in last two weeks.

Answered by Dr. Satyadeo Choubey (10 minutes later)

Brief Answer: Repeat the tests if too old Detailed Answer: Thanks for follow up. Its a significant weight gain. You must report these two tests if they are old enough. In liver function test have a close look to SGOT/PT, Bilirubin and albumin levels..A lower albumin may lead to this presentation. In kidney look for urea, creatinine, electrolytes. If she is on thyroid medication repeat this test too....and ECHO must now...

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Satyadeo Choubey (3 minutes later)

Ok We will repeat these test I have just uploaded last reports for your review Thanks

Answered by Dr. Satyadeo Choubey (4 minutes later)

Brief Answer: Go as advised Detailed Answer: Sorry I just saw the report. Hb and albumin are on lower side....cause of swelling will be clear on new report...So go through CBC, LFT and RFT first and if required, then ECHO will be done... Best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Satyadeo Choubey (46 hours later)

I have just uploaded Ascites Fluid Examination Report and some recent reports.It reveals that her Serum Albumin is 3.278 gm/dl,Fluid Albumin is 1.778 gm/dl (SAAG is 1.50 ) Sodium is on Lower Side 119.4 & S. Pottasium is 5.64 mEq/l Please Suggest ? I check SAAG on internet and found that SAAG >= 1.1 suggests presence of portal hypertension...Please Advise?.Need some Clarity

Answered by Dr. Satyadeo Choubey (11 hours later)

Brief Answer: Go for USG and stop if taking diuretics.. Detailed Answer: Thanks for your follow up. You are very right that SAAG>1.5 suggests portal hypertension, but here it may be secondary to some lymph node pressing over the portal vein. One thing here is low sodium and high potassium level... I will advise you to go for USG abdomen to especially look for liver and its echotexture and portal vein. Also going for fasting cortisol level will be helpful (for decreased sodium and increased potasssium.), if the patient is not on diuretics like lasix. And if she is on it ...it must be stopped immediately.... Best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Satyadeo Choubey (2 days later)

Thanks for the Suggestion Yes she was taking lasix from last 2 weeks.She now recovered from excessive swelling and now back to her normal weight.I am afraid if she stops lasix than this may result in wait gain.Can you please suggest another alternative to lasix?? Also want to know if the lymph node is pressing over the portal vein.what will be treatment like?..what are the complications?.Is it possible to cure by medicines?

Answered by Dr. Satyadeo Choubey (9 hours later)

Brief Answer: Lasix to be withhold for few days Detailed Answer: Thanks for follow up. Lasix can be withhold for few days . One of the side effect of lasix is decreased sodium level and in recent report, it has come down to a XXXXXXX level of 119. If the lymph nodes are due to tuberculosis, they will regress by anti-TB treatment... Best wishes

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Satyadeo Choubey (3 days later)

Her Liver Fibro Scan Indicates Median 18.0 and her serum creatinine are on higher side 2.2.ECHO found ok Please check the uploaded reports and suggest?

Answered by Dr. Satyadeo Choubey (1 hour later)

Brief Answer: Follow the advice of gastroenterologist.... Detailed Answer: Thanks for follow up. It seems that she may have increased stiffness of liver probably cirrhosis ( as score is 18). Follow the advice of gastroenterologist.... Best wishes

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar