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What Do These AKT Levels Inspite Of Suffering From Bone TB Indicate?
Question: I have had Multifocal Bone TB in Nov'2013. I have disclosed this medical history while subscribing for a term Insurance policy and now they are asking lot of questions for which I am unable to answer. I need some help in identifying the following :
1..if there was actually a problem as mentioned " Filling defect in superior venacava suggestive of Thrombus" & "Jugular vien not visualised"on page no 7 of the attached report
2. is or was there a problem or how can I establish substantiate ?
Sorry it was November 2003 and not 2013.
also I am not sure why was chest CT scan done when I had Bone TB of left Tibia and also Biopsy has confirmed the same.
I am also facing questions from the insurance company about "why was this identified and why were you not treated for this" ?
I am not able to answer this questions. I have moved to different city now and I cannot go back to same hospital and doctor to get the answers.
request your help.
I have latest health check records to substantiate that I am fit and fine.
1..if there was actually a problem as mentioned " Filling defect in superior venacava suggestive of Thrombus" & "Jugular vien not visualised"on page no 7 of the attached report
2. is or was there a problem or how can I establish substantiate ?
Sorry it was November 2003 and not 2013.
also I am not sure why was chest CT scan done when I had Bone TB of left Tibia and also Biopsy has confirmed the same.
I am also facing questions from the insurance company about "why was this identified and why were you not treated for this" ?
I am not able to answer this questions. I have moved to different city now and I cannot go back to same hospital and doctor to get the answers.
request your help.
I have latest health check records to substantiate that I am fit and fine.
Brief Answer:
Multi-focal /disseminated tuberculosis -treated
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
You have been diagnosed and treated for multi-focal /disseminated tuberculosis with a primary focus at upper shaft of Lt tibia ( as proven by bone biopsy).
You have improved with AKT for 18 months.
CT chest was done to find out the extent of dissemination and it showed mediastinal lymphadenopathy leading to compression and thrombosis of superior vena cava (SVC) and consequent non -visualisation of right internal jugular vein which is a direct drainage tributory of SVC.
Since mediastinal lymphadenopathy is of infective etiology (in your case disseminated tuberculosis ),the primary treatment remained AKT(Anti-Kochs Treament) and mediastinal lymphadenopathy must have subsequently regressed with AKT and recanalisation of SVC and right internal jugular vein eventually occured, as you are symptom free now.There was no requirement of separate treatment for CT chest findings.Was there any repeat CT Chest after the completion of AKT for 18 months. If done, it would further resolve the dispute raised by your insurance company. In any case the query raised by the company is answered.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Multi-focal /disseminated tuberculosis -treated
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
You have been diagnosed and treated for multi-focal /disseminated tuberculosis with a primary focus at upper shaft of Lt tibia ( as proven by bone biopsy).
You have improved with AKT for 18 months.
CT chest was done to find out the extent of dissemination and it showed mediastinal lymphadenopathy leading to compression and thrombosis of superior vena cava (SVC) and consequent non -visualisation of right internal jugular vein which is a direct drainage tributory of SVC.
Since mediastinal lymphadenopathy is of infective etiology (in your case disseminated tuberculosis ),the primary treatment remained AKT(Anti-Kochs Treament) and mediastinal lymphadenopathy must have subsequently regressed with AKT and recanalisation of SVC and right internal jugular vein eventually occured, as you are symptom free now.There was no requirement of separate treatment for CT chest findings.Was there any repeat CT Chest after the completion of AKT for 18 months. If done, it would further resolve the dispute raised by your insurance company. In any case the query raised by the company is answered.
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you Doctor.
In the last 11 years I was not even aware of any such symptom related to thrombosis of SVC. so I never went for any CT chest, I have done Chest X Rays as part of routing health check.
Only when the insurance company raised , I go to know.
Even the consulting doctors never mentioned this condition ,what I have understood was that they were suspecting malignancy ,but as biopsy proved it was TB.
Does the symptom of this condition remain dormant for 11 years ?
Does any test of routine health check prove that I am free of this condition now ?
I had one more question.
In the report of Nov 2003, page 7 after going through details it looks like there is contradicting views...line 7 states-
"No evidence of any other mediastinal or hilar adenopathy "
again in same page under "Impression" point 1 it states otherwise,
In the last 11 years I was not even aware of any such symptom related to thrombosis of SVC. so I never went for any CT chest, I have done Chest X Rays as part of routing health check.
Only when the insurance company raised , I go to know.
Even the consulting doctors never mentioned this condition ,what I have understood was that they were suspecting malignancy ,but as biopsy proved it was TB.
Does the symptom of this condition remain dormant for 11 years ?
Does any test of routine health check prove that I am free of this condition now ?
I had one more question.
In the report of Nov 2003, page 7 after going through details it looks like there is contradicting views...line 7 states-
"No evidence of any other mediastinal or hilar adenopathy "
again in same page under "Impression" point 1 it states otherwise,
Brief Answer:
Mediastinal lymphadenopathy, thrombosis of superior vena cava (SVC)
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
The only test that can confirm that mediastinal lymphadenopathy have completely regressed and thrombosis of superior vena cava (SVC) has resolved and lower part of right internal jugular vein which was not visualized in Nov 2013 CT chest is now visualized ,after completion of AKT is a follow-up HRCT(High-resolution computed tomography) chest.
Routine health check-up which has been done in Jul 2014 shows your ESR-22 mm (high).ESR may be high in tuberculosis, though it is not a good guide.
The only Investigation which is of some relevance in this regard in Jul 2014 is your 2-D echo-cardiography which has not shown any abnormality. If SVC thrombosis would have been there, it would have shown some evidence of obstruction even if it is partial on 2-D Echo-cardiography.
The tracheo-bronchial lymph nodes are arranged in five main groups: pulmonary, broncho-pulmonary, sub-carinal, superior tracheo-bronchial and paratracheal.
In practical terms: these form a continuous network of nodes from the lung substance up to the trachea and constitute mediastinal lymphodes. All the groups was not involved in your case-hence the report of "No evidence of any other mediastinal or hilar adenopathy ".
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Mediastinal lymphadenopathy, thrombosis of superior vena cava (SVC)
Detailed Answer:
Hi,
Thank you for your query. I can understand your concerns.
The only test that can confirm that mediastinal lymphadenopathy have completely regressed and thrombosis of superior vena cava (SVC) has resolved and lower part of right internal jugular vein which was not visualized in Nov 2013 CT chest is now visualized ,after completion of AKT is a follow-up HRCT(High-resolution computed tomography) chest.
Routine health check-up which has been done in Jul 2014 shows your ESR-22 mm (high).ESR may be high in tuberculosis, though it is not a good guide.
The only Investigation which is of some relevance in this regard in Jul 2014 is your 2-D echo-cardiography which has not shown any abnormality. If SVC thrombosis would have been there, it would have shown some evidence of obstruction even if it is partial on 2-D Echo-cardiography.
The tracheo-bronchial lymph nodes are arranged in five main groups: pulmonary, broncho-pulmonary, sub-carinal, superior tracheo-bronchial and paratracheal.
In practical terms: these form a continuous network of nodes from the lung substance up to the trachea and constitute mediastinal lymphodes. All the groups was not involved in your case-hence the report of "No evidence of any other mediastinal or hilar adenopathy ".
Regards
Dr. T.K. Biswas M.D. XXXXXXX
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Answered by
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