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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
Satisfied Customers: 26383
Experience:  Over 20 yrs of Family Practice
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1.7 precarinal node. Nothing else remarkable. CT ordered after

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1.7 precarinal node. Nothing else remarkable. CT ordered after week long undiagnosed lung infection (Pain in upper chest and back, some mucus but no sinus involvement, weakness, some cough) that resolved, though was followed by one morning of coughing up bloody mucus, which was not repeated. [My personal guess is the infection was a new occurrence of a herpes infection which started in the mouth some years ago and migrates further south with each new episode.]
Lost 50 lbs in 5 months, with major change in eating habits and heavy exercise. Not unexplained weight loss, but...lowered appetite that coincided with going on pristiq. 57 year old male, good general health.
Anyway, chalk the node to the infection, or further study?
Hi--have you ever had a chest x-ray in the past?
Customer: replied 3 years ago.

yes. 3+ years ago. And before this CT. I left that out for brevity's sake. In both cases, a nodular focus was seen in the xray that lead to the CT request. In the first case, it turned out to be no nodular density, but some structural feature. This time, also no density, but they didn't have the xray to compare (I had to go to a hospital for CT because I have an iodine allergy ant the second CT was ordered w/contrast.) He noted a large right-sided spur present at T7-T8.

Sorry--I'm a bit confused. Are you saying the same density was seen three years ago?
Customer: replied 3 years ago.

Yes. On both xrays, one 3+ years ago and another 2 weeks ago, a density was seen and a CT war ordered to further study. In both CTs, no density was seen, but some structural feature was suggested to be the origin of the "density" noted on xray.

The adenopathy (1.7cm precarinal node) was not seen 3 years ago.

OK. You need a PET scan to look at this more precisely but yes it could be just a persistently enlarged node secondary to infection. I would have it re-evalued in about three to six months to see if it has enlarged but I don't think a biopsy is warranted at this time.
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