Question: Itchy soft lump near spine at the middle part of my back. Pain in the bone on the back and pain seems to come from the inside of my chest out to the back area where it itches and their is a small soft lump.

There is no rash or red area/nothing to photograph. It itches and the lump is under the skin. I will do my best to get a photo and upload. I have this information from a CT scan in April. My Rheumatologist said it isn't old granulomes because they would show positive on a TB test. No positives on my TB test. Technique: Helical CT of the chest was performed without contrast. Multiplanar reformations were performed.

Findings: Bilateral calcified pulmonary granulomas are noted, up to 4 mm in size. Left hilar lymph node calcifications are also seen. There are no enlarged mediastinal or axillary lymph nodes. There is no pulmonary infiltrate. There is no pleural effusion or pneumothorax. The heart and great vessels are unremarkable.

Calcified granulomas are also seen in the spleen. Visualized portions of the liver, pancreas, kidneys and adrenal glands are unremarkable. There are mild degenerative changes of the spine.

Impression: Old granulomatous disease involving lungs, hilar lymph nodes and spleen.

There is no rash or red area/nothing to photograph. It itches and the lump is under the skin. I will do my best to get a photo and upload. I have this information from a CT scan in April. My Rheumatologist said it isn't old granulomes because they would show positive on a TB test. No positives on my TB test. Technique: Helical CT of the chest was performed without contrast. Multiplanar reformations were performed.

Findings: Bilateral calcified pulmonary granulomas are noted, up to 4 mm in size. Left hilar lymph node calcifications are also seen. There are no enlarged mediastinal or axillary lymph nodes. There is no pulmonary infiltrate. There is no pleural effusion or pneumothorax. The heart and great vessels are unremarkable.

Calcified granulomas are also seen in the spleen. Visualized portions of the liver, pancreas, kidneys and adrenal glands are unremarkable. There are mild degenerative changes of the spine.

Impression: Old granulomatous disease involving lungs, hilar lymph nodes and spleen.

These are the results of my bone density test:

PROCEDURE: A bone mineral density examination of the left proximal femur and AP lumbar spine was performed using a Lunar Prodigy Advance dual-energy x-ray absorptiometry (DXA) system manufactured by GE Healthcare. The following summarizes the results of the evaluation with comparison to databases of both a young adult reference population (T-score) and a race, gender and age-matched normal population (Z-score).

FINDINGS: The bone mineral density measured at L1-L4 is 0.828 gm/cm2 with a T-score of -3.0 and a Z-score of -2.5.

The bone mineral density measured at the femoral neck is 0.733 gm/cm2 with a T-score of -2.2 and a Z-score of -1.4.

Additional sites of evaluation, Z-scores, and trending data can be found in the PACS accessed through Synapse.

IMPRESSION: This patient is considered osteoporotic according to World Health Organization (WHO) criteria. The risk of fracture is high and pharmacologic treatment, if not already prescribed, should be started. A follow-up bone density test is recommended in one year to monitor response to therapy.
Amended Report:
STUDY: DXA BONE MINERAL DENSITOMETRY

PROCEDURE: A bone mineral density examination of the left proximal femur and AP lumbar spine was performed using a Lunar Prodigy Advance dual-energy x-ray absorptiometry (DXA) system manufactured by GE Healthcare. The following summarizes the results of the evaluation with comparison to databases of both a young adult reference population (T-score) and a race, gender and age-matched normal population (Z-score).

FINDINGS: The bone mineral density measured at L1-L4 is 0.828 gm/cm2 with a T-score of -3.0 and a Z-score of -2.5.

The bone mineral density measured at the femoral neck is 0.733 gm/cm2 with a T-score of -2.2 and a Z-score of -1.4.

Additional sites of evaluation, Z-scores, and trending data can be found in the PACS accessed through Synapse.

IMPRESSION: This patient is considered osteoporotic according to World Health Organization (WHO) criteria. The risk of fracture is high and pharmacologic treatment, if not already prescribed, should be started. A follow-up bone density test is recommended in one year to monitor response to therapy.

Result of MRI of spine:

Findings: The signal, height and alignment of the thoracic vertebral bodies are within normal limits. There is no acute or aggressive bone marrow signal abnormality. There are mild multilevel ventral endplate degenerative changes. Disc heights and signal intensities are within normal limits for age. There is a small left paracentral to neural foramen disc protrusion at T8-T9 without significant spinal canal or neural foramen stenosis. The remaining thoracic disc levels are without disc herniation. There is no thoracic spinal stenosis or spinal cord compression. The visualized paraspinal soft tissues are normal in signal. The demonstrated spinal cord is normal in signal and terminates at a normal level.

Impression: Mild multilevel degenerative changes of the thoracic spine, with a small disc protrusion at T8-T9, as above. No significant thoracic spinal stenosis

Result of MRI, lower ext:

Technique: Axial and sagittal imaging using T1, fat-suppressed fast spin echo T2, and T1 post gadolinium weighted imaging was performed. The exam covers from the left ischial tuberosity to the distal femur.

Findings: The hamstring origins demonstrate thickening and an atypical appearance of the semimembranosus origin. There is also mild atrophy of the quadratus femoris muscle. The distal portion of the study again demonstrates increased T2 signal in the semimembranosus muscle as well as fatty infiltration of the muscle consistent with atrophy. The remaining posterior muscles have normal signal. The anterior muscles also have normal signal.

No hematoma or edema is appreciated along the course of the sciatic nerve.

Impression: 1. Mild increase in atrophy of the semimembranosus muscle. 2. Mild atrophy of the quadratus femoris muscle.

The patient will be contacted to return for comparative imaging of the right ischial tuberosity as there may be a chronic semimembranosus origin tear with subsequent scarring. The symptoms could be related to scarring or perineural fibrosis involving the proximal sciatic nerve or injury to a branch of the nerve supplying the semimembranosus muscle.

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