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Undiagnosed Symptoms (Expert Forum)
Enlarged Lymph Nodes (Mediastinal, Hilar, etc) + Wide Range of Symptoms
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
Questions in the Undiagnosed Symptoms forum are answered by Dr. Kevin Pho. Topics covered include breathing difficulties, feeling cold, cough, diarrhea, dizziness, fainting, fever, indigestion, itching, nausea, numbness, pain (chronic), paralysis, rash, sweating, swelling, urination problems, and vomiting.
Enlarged Lymph Nodes (Mediastinal, Hilar, etc) + Wide Range of Symptoms
by sguedes, Apr 02, 2007 12:00AM
Thanks for the opportunity to post! In Jul 2005 a CTscan found a 1.9CM mediastinal lymph node in my husband’s aorticopulmonary window (the scan was to locate a Pheochromocytoma; the pheo was found inside his R adrenal gland and tumor/gland were removed). He has had 4 more CTscans. The aorticopulmonary node identified in 2005 seems unchanged but CTscan of 3/14/07 also refers to the following nodes, which were not mentioned in 2005: "small lymph node of less than 1 CM in the right hilum" & "mild lymphadenopathy in the aortic arch".
He is 53 yr old & experiencing wide array of symptoms: 1)Lack of energy, 2)Chronic Sinus Congestion that looks like allergies. Nose looks swollen & sinuses are inflamed but otherwise normal, 3)Dry Mouth 4)Shortness of Breath w/mild exertion. At times "trying to get air" even at rest (odd since he's very active & able to play basketball & golf) 5)Sleep Disturbances (highly unusual). 6)Acid Reflux/Heartburn worse at night. 7)Some difficulty swallowing; must have drink at hand to avoid choking. Had Barium GI X-ray exam but no results yet. 8)Low level of interest in things & low libido. Since Dec, for first time ever, has had mild sexual dysfunction. 9)Snoring, 10)Was diagnosed with Rosacea & Ocular Rosacea in spring 2006; had lots of rosacea symptoms for months but is OK now 11)Occasional unexplained anxiety (his personality is VERY relaxed/happy) 12)Infrequent Mild Chest Pains; lasts only a few minutes. 13)Last year he got 1-2 small inflamed bumps on shins, one shin at a time. 14)No weight loss. 15)Only occasional cough.
TESTS: Blood Serum Total Protein= 9.3g/dl (lab range 6.0-8.2). Blood & Urine Electrophoresis= "Polyclonal Gammopathy (Gamma= 2.93g/dl, range= 0.60-1.60, Gamma Fraction= 33.3%, Total Protein= 8.8g/dl). 24-hr urine: Normetanephrine= 295MG, Total Metanephrine= 370MG. Will have "Pulmonary Function" & "Overnight Oximetry" tests this week.
Should PET and/or biopsy be next steps? Thx in advance for your help!
He is 53 yr old & experiencing wide array of symptoms: 1)Lack of energy, 2)Chronic Sinus Congestion that looks like allergies. Nose looks swollen & sinuses are inflamed but otherwise normal, 3)Dry Mouth 4)Shortness of Breath w/mild exertion. At times "trying to get air" even at rest (odd since he's very active & able to play basketball & golf) 5)Sleep Disturbances (highly unusual). 6)Acid Reflux/Heartburn worse at night. 7)Some difficulty swallowing; must have drink at hand to avoid choking. Had Barium GI X-ray exam but no results yet. 8)Low level of interest in things & low libido. Since Dec, for first time ever, has had mild sexual dysfunction. 9)Snoring, 10)Was diagnosed with Rosacea & Ocular Rosacea in spring 2006; had lots of rosacea symptoms for months but is OK now 11)Occasional unexplained anxiety (his personality is VERY relaxed/happy) 12)Infrequent Mild Chest Pains; lasts only a few minutes. 13)Last year he got 1-2 small inflamed bumps on shins, one shin at a time. 14)No weight loss. 15)Only occasional cough.
TESTS: Blood Serum Total Protein= 9.3g/dl (lab range 6.0-8.2). Blood & Urine Electrophoresis= "Polyclonal Gammopathy (Gamma= 2.93g/dl, range= 0.60-1.60, Gamma Fraction= 33.3%, Total Protein= 8.8g/dl). 24-hr urine: Normetanephrine= 295MG, Total Metanephrine= 370MG. Will have "Pulmonary Function" & "Overnight Oximetry" tests this week.
Should PET and/or biopsy be next steps? Thx in advance for your help!
Doctor's Answer
by Kevin Pho, MD, Apr 02, 2007 12:00AM
, Apr 02, 2007 12:00AM
These are a wide constellation of symptoms, that may or may not have a unifying diagnosis.
If the hilar lymph nodes remain suspicious, a biopsy can be considered - however this is in a risky location and the biopsy itself would have a risk of complications. A PET scan can be considered.
Regarding the fatigue and loss of libido, various blood tests can be considered including thyroid, CBC, metabolic panel, vitamin B-12, and testosterone levels.
Acid reflux and difficulty swallowing should be evaluated with an upper endoscopy to evaluate for any blockages.
Snoring and sleep disturbances can be evaluated with a sleep study to rule out apnea.
I agree with the pulmonary function testing for the shortness of breath. Cardiac testing, like a stress echocardiogram, can also be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
If the hilar lymph nodes remain suspicious, a biopsy can be considered - however this is in a risky location and the biopsy itself would have a risk of complications. A PET scan can be considered.
Regarding the fatigue and loss of libido, various blood tests can be considered including thyroid, CBC, metabolic panel, vitamin B-12, and testosterone levels.
Acid reflux and difficulty swallowing should be evaluated with an upper endoscopy to evaluate for any blockages.
Snoring and sleep disturbances can be evaluated with a sleep study to rule out apnea.
I agree with the pulmonary function testing for the shortness of breath. Cardiac testing, like a stress echocardiogram, can also be considered.
These options can be discussed with your personal physician.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
kevinmd_
Maybe the PFT has shown something, I know I am commenting on this a bit late - But have you asked for an ACE level blood test?
Hope he is feeling better now.
Regards
J