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Julia Kizhner
Julia Kizhner, Physician Assistant
Category: Health
Satisfied Customers: 1126
Experience:  7 years experience working in Primary Care as well as Gastroenterology, Sleep Medicine & Weight Loss
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I'm 58 years old. I weigh 50kg and I'm 1.54m tall. I have

Resolved Question:

Hello doctor. I'm 58 years old. I weigh 50kg and I'm 1.54m tall. I have been having chest pains which spreads to the back and arms since last November. My cardiologist did all the necessary tests and I was told my heart is fine. I was referred to a thoracic specialist and sent for a CT scan of the chest area. My recent chest CT scan revealed a stable soft tissue nodule in the anterior mediastinum and multiple hypodensities - (largest measuring 2.5 x 2.7 cm) seen in the visualised liver. I have a strong history of breast cancer in my family. 2 of my sisters have breast cancer and 1 sister has ovarian cancer (all of them still undergoing treatment). Should I ask for more tests although the report ended with these word : "Abnormal - known/minor"? If so, what kind of tests should I ask for? Thank you.
Submitted: 6 years ago.
Category: Health
Expert:  Julia Kizhner replied 6 years ago.

Hello and thank you for your question,

Liver hypodensities are usually benign findings and most often represent fatty deposits in the liver. I do not believe that these hypodensities are the cause of your symptoms, however, I would recommend follow-up CT scan in 4-6 months to make sure the size has not changed.

Now more to your question of chest pains. I am assuming that you get regular mammogram and they have been normal. Otherwise, you definitely need a mammogram. Quite often, chest pains that you are describing can be caused by acid reflux so I would recommend seeing a gastroenterologist for an endoscopy as CT scan is unable to pick up what is going on in your stomach. During endoscopy you will also have a test for H. pylori infection. H. pylori is bacteria which lives in the lining of the stomach and which can cause upper abdominal and chest pains.

You also might consider getting evaluation of your gallbladder, specifically HIDA scan which will measure the functionality of the gallbladder.

Knowing that your heart is in good condition is great news.

I hope you find this information helpful. Please feel free to follow-up with any other questions you might have.

If you are satisfied with the answer, please do click 'Accept' button so that I may get credit for my work.

Best wishes and good luck,


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Customer: replied 6 years ago.
Thank you for your prompt reply. I've had my mammogram done last October and results shown were a small left breast cyst and numerous well circumscribed hypoechoic foci, all stable, seen in both breasts. Due for another mammogram this October. I also had endoscopy done in January this year and the diagnosis was endoscopic polypectomy - fundic gland polyp and dilated glands (don't know what all these mean because the doctor who did the endoscopy didn't explain to me). All he told me was that I had 2 big polyps and that they were not malignant. However, he did suggest that maybe I should resign from my job. Despite all these tests, I still continue to have chest pains and they do get to be quite annoying. Recently, these two days, I also get a dull ache on my right abdomen. By the way, I forgot to mention that I've Graves Disease and had undergone radio-active iodine in the 1990's. Unfortunately the procedure had "over-killed" and thus I'm now hypo and on thyroxine. So each time I'm referred to a specialist, they kept referring me back to my endocrinologist. It's so frustrating.
Expert:  Julia Kizhner replied 6 years ago.

Thanks for the additional information.

Why did GI doctor recommend you resigning from your job? Is it very stressful?

Polyps in the stomach are common, they are just benign growths but they would definitely not cause your symptoms. Did he mention anything about inflammation in the stomach or esophagus?

Can you tell me a little bit more about the pains you have? Do they happen after you eat? or randomly? or after exercise? Do they get worse with deep breathing or moving? Any nausea during the pain episodes? How long do these episodes last and what makes them go away?

Customer: replied 6 years ago.

Yes. My job is rather stressful. He recommended resignation because he felt that my gastro problems are due to irregular meal times. He didn't mention inflammation in stomach or esophagus but the histopathology report given to me described no helicobacter colonisation, metaplasia, dysplasia or malignancy.

As for the pains - it comes randomly and usually quite unexpectedly. On a few occasions, it came in spasms - the 1st time it happened I thought I was having a heart attack, the reason why I was referred to a cardiologist. The first attack was a few weeks after a viral infection. Since then, it's been on and off. On a few occassions, the pain woke me up from my sleep and this is often followed by nausea. At times, the pain is just a consistent ache on my left side and this is often followed by a numbness that spreads to my arm and sometimes to my back. Each episode can last a few seconds to a minute or so. The longest episode was 3 minutes. I don't know what makes the pain go away each time but it seems resting and taking deep breaths help.

Expert:  Julia Kizhner replied 6 years ago.

Thanks again for the information.

Well, it is possible that acid reflux can be the cause of your symptoms (especially since it can happen at night and sometimes is followed by nausea) but with relatively normal endoscopy and with symptoms only lasting a few seconds to minutes, it is unlikely.

What comes to mind is anxiety. Sometimes stress at work (and not just at work) can cause you to have these mini-panic attacks that are manifested with chest pains. Often they are accompanied by numbness and tingling and often people to confuse them for heart attacks. If these episodes are frequent (I forgot to ask you how frequent they are), you might consider trying a low-dose anti-anxiety medication (such as Lexapro) to see if that improves your symptoms (takes up to 4 weeks before it begins to fully work). Please consider discussing this with your GP. I do not think the thyroid is the culprit of your symptoms.

Please let me know if you have any other questions.


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Customer: replied 6 years ago.
Thank you so much Julia for your advise. Really appreciate it.
Expert:  Julia Kizhner replied 6 years ago.
You are very welcome. I am glad I was able to help :)