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Anthony Bray, MD
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Category: Medical
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Experience:  14 years experience in the field of Family Practice
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My Mother recently had a CT scan and the report came back with

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My Mother recently had a CT scan and the report came back with this interpretation: Prominent mediastinal lymph nodes, most prominent being a subcarinal nodal mass measuring 1.7 cm short axis. Mildly prominent heart with dilated left atrium and left ventricle. Minimal ascites over the convexity the spleen and mild thoracic spondylitis.

Moderate right greater than left posterior layering pleural effusions with partial passive atelectasis of the right lower lobe. The lungs are otherwise clear and pulmonary vascularity is unremarkable without definite vascular congestion or frank pulmonary edema.

There are prominent prevascular, right paratracheal and subcarinal lymph nodes, the most prominent being a subcarinal nodal mass measuring 1.7 cm short axis. Largest prevascular and paratracheal nodes approach 1.1 cm short axis. There is a prominent heart with dilated left atrium and left ventricle. Mdeiastinal and thoracic inlet structures otherwise unremarkable.

She was also diagnosed with atrial fibrillation and had a cardioversion to put her heart back into rythem which was successful. The Cardiologist stated the lung effussions could have put my Mother in atrial fibrillation.

Is it possible to have a non malignant mass in your mediastinal and subcarinal lymph nodes.

Could you please interpret this report for me in laymen terms?

My Mother has appointments with a Pulmonary and Cardiac Thoracic Surgeon this next week.
Submitted: 1 year ago.
Category: Medical
Expert:  Anthony Bray, MD replied 1 year ago.

Anthony Bray MD : Hello!
Anthony Bray MD : Well for starters as you probably know she has some enlarged lymph nodes of the lungs and chest....
Anthony Bray MD : the enlarged lymph nodes could be reactive from a pulmonary infection .... Tuberculosis should be ruled out... Other infection causing this would be most likely cause though ...
Anthony Bray MD : the enlarged lymph nodes may bring up certain cancers such as lymphoma but pattern to me does not seem that suggestive of this... I would probably advise serum protein electrophoresis and urine protein electrophoresis tests to help rule out lymphoma as possible cause....
Anthony Bray MD : biopsy and cultures may be considered BUT
Anthony Bray MD : biopsy is a high risk procedure in the chest area ....
Anthony Bray MD : The pleural effusions mean fluid has collected under both lungs ....
Anthony Bray MD : the fluid collections may be caused by prior pneumonia ( no evidence if current pneumonia infection) it could be caused by CHF ( congestive heart failure) thisay have developed because of the atrial fibrillation rather than the other way around ... Atrial fibrillation decreases the hesrt's flow output by 15 %... So it would be possible that her atrial fibrillation could have lead to the fluid collections under the lungs....
Anthony Bray MD : this type of fluid collection has many possible causes...
Anthony Bray MD : CHF, infections, certain autoimmune disease, certain viral infections, and atypical infections including TB must be considered as possible causes. I would expect that she will probably be advised follow up to see if these effusions clear with time...
Anthony Bray MD : It is possible that a mediastenoscopy with biopsy MIGHT be considered or recommended but this procedure is fairly involved and does have risk so this decision is weighed against options such as completing other tests and waiting to follow up the subcarinal lymph nodes ( this is where the bronchi of the lungs bifurcate off from the trachea-- so center chest area...)such as with a follow up CT IN 1 month to see if the lymph nodes have become larger or smaller with time...
Anthony Bray MD : Many aspects of her report are positive such as her lungs appearing clear for the most part ( indicating a lack of signs of pneumonia or CHF or a lung based cancer)
Anthony Bray MD : The prominent left atrium probably relates to her having some chronic mitral valve regurgitation and this also probably ties in with the atrial fibrillation history ....
Anthony Bray MD : I hope that this is helpful to you so far!! You may have further questions. Let me know and I will be happy to get back with you!!
Anthony Bray MD : If my answers have been helpful and to your satisfaction then please remember to leave positive feedback. That would be very much appreciated! Thank you and best regards,
Anthony Bray MD : Anthony Bray MD
Anthony Bray MD : The partial passive atelectasis simply means that the lung in this area is not fully expanded. It compares to a sponge that is slightly squished....
Anthony Bray MD : Atelectasis is generally just a transient finding... May be helped by deep breathing exercises....
Anthony Bray MD : Minimal ascites just means fluid --- this was seen located near the spleen... Does not appear to be clinically significant ....
Anthony Bray MD : Thoracic spondylitis translates into arthritis of the spine--- not a surprising or particularly concerning finding there...
Anthony Bray MD : Again I hope that this has helped! Let me know if you have further questions!
Anthony Bray MD : Best regards ,
Anthony Bray MD : Anthony Bray MD
JACUSTOMER-lw2fgs44- :

Mom's Cardiologists ruled out CHF about a month ago. But her echo cardigram did show mild mitral valve regurgitation. She has had pneumonia a couple of times within the last 5 years.

Anthony Bray MD : I see. Well I think it possible that the new but mild pleural effusions might have related to her atrial fibrillation as a possible cause. I think something causing inflammation may be more likely due to the combined findings of the enlarged lymph nodes and the mild pleural effusions. A malignant process would be a potential concern but it looks more like an infectious process to me. I think consideration should include TB skin tests, CBC, ANA, sed rate , C - reactive protein( these last three screening for inflammation and autoimmune disease such as vasculitis or lupus)
Anthony Bray MD : Antibodies for mycoplasma would be reasonable ... Common respiratory infection...
JACUSTOMER-lw2fgs44- :

Her cardiologist just put her on a half a lasix a day. Her breathing is already better. Mom was in the hospital last October because of heart palpatations and very high blood pressure. After an echo and chest xray and were able to get her blood pressure down, they sent her home the next day. But she was not in atrial fibrillation then. But she did follow up with her doctors.

Anthony Bray MD : Ok well the atrial fibrillation would reduce her heart efficiency while she had it.. It could be that the Afib temporarily put her in a state of CHF( meaning only that the work needs of the heart are exceeding the heart output... This may have corrected with the correction of her Afib and improved blood pressure....
Anthony Bray MD : it sounds that she improved with treatment of her blood pressure plus the diuretic plus correction of the Afib --- this seems consistent to me with her possibly improving from CHF even though her echo would not have suggested CHF and her chest X-ray now does not indicate certain signs of CHF such as overly expanded pulmonary blood vessels....
Anthony Bray MD : We have to keep in mind too that the echo only shows one point in time....
Anthony Bray MD : I hope that this is helpful to you! Let me know if you have further questions or discussion and I will be happy to get back with you !
JACUSTOMER-lw2fgs44- :

Thanks for all your help and information. You certainly explained it so I can understand this information. I just wish more MD's would explain things in detail, and I'm sure as patient we need to ask questions. But sometimes we are just so overwhelmed the results of the test that we can't even think of the questions while we are in the Doctor's office.

JACUSTOMER-lw2fgs44- :

Could you please send this chat to my email address? I cannot open it fully and print it.

JACUSTOMER-lw2fgs44- :

My email address is: XXXXX@XXXXXX.XXX.

JACUSTOMER-lw2fgs44- :

Sincerely, Debra.

JACUSTOMER-lw2fgs44- :

Mom's doctor told her she would have to be on a blood thinner the rest of her life. He said because she wouldn't know when she went into atrial fibrillation again. She has a blood pressure machine that shows her heart rate and even has an alarm when she's in afib. I still have a hard time believing she should stay on this thinner if she's out of afib. What do you suggest?

Expert:  Anthony Bray, MD replied 1 year ago.
Hello again,

I can't send to your email as Justanswer.com automatically blocks your email and would block mine for privacy protection both directions.... I have switched the format to Q and A format. This should allow you to print the screen. I hope this helps! Let me know if you have further questions or if I may help in any other way!!

I hope that your mother does well! Happy 4th! Best regards!!

Anthony Bray MD
Anthony Bray, MD, Doctor
Category: Medical
Satisfied Customers: 6484
Experience: 14 years experience in the field of Family Practice
Anthony Bray, MD and 2 other Medical Specialists are ready to help you
Expert:  Anthony Bray, MD replied 1 year ago.
Hi again,

I hope that you were able to print the page after I changed the format. Let me know if I may be of further help!

Best regards,

Anthony Bray MD

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