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Chest Pain with Recent Swollen Lymph Glands
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Chest Pain with Recent Swollen Lymph Glands

I have a very very very complicated long medical history.  So, I'm going to shorten this down to the basics.

For about 3 years I've had a sharp stabbing pain in my chest that comes and goes.  It does happen a lot when I breath deep (such as pleurisy).  I've had numerous CT scans that shows a small nodule in the LLL, but since it's never changed size, they've determined that it's not cancerous.  They did say that I have a ground glass affect with bronchietasis and emphysema though.  I'm a 41 year old female smoker.  I also had a PET scan that didn't show any cancer.

So anyway, for the past 3-4 weeks I've had a good-sized swelled lymph gland on the left side of my neck.  Some days it seems more prominent than other days (but I don't think the size actually changes).  It doesn't hurt whatsoever.  No sore throat.  No fever.  No aches or pains (except for the occasional lung pain as mentioned above).  I have, however, for the past year, felt like something is in my throat (on and off).  I'm constantly swollowing.  I did see an ENT about a year ago when this first started, and she took a quick looksy down my throat, but she didn't see anything except for it was (quote) "extremely red".....She was really surprised that it didn't hurt (but it didn't).

Anyway, what do you think???  Should I go to the doctor, or should I just wait to see if the gland swelling goes down???  If I do need to see a doctor, should I see my Internal Medicine doctor, or an ENT???

Thanks,

Risinghigh


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322973_tn?1239908038
Hi,
A painless swollen lymph node in the neck that is persisting for a long time needs further investigation. The commonest causes are infection and cancer. A fine needle aspiration cytology from the node would help in the diagnosis. Smoking increases the risk of developing many cancers including head and neck cancer,lung cancer, breast cancer, esophageal cancer etc. You need to see your doctor again for a checkup and investigations. You would need to undergo a thorough ENT examination in addition to other investigations to diagnose your condition.
Once again, I strongly urge you to quit smoking.
All the best, and God Bless!
15 Comments
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Avatar_n_tn
By the way, I had the PET scan and last CT scan about 1 - 1 1/2 years ago!

Risinghigh
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Avatar_n_tn
Dr. Saini,

Thank you so much for your quick response.  Honestly, deep down, I think I already knew what you were going to say.  I guess I'm just experiencing plausible deniability.  I'm just really truly concerned about this swollen lymph gland.  Like I told you before, I have an extremely complicated and long medical history, but even with all of that in my past, including some very serious illnessess, I don't think I've ever been as concerned as I am right now regarding the swollen lymph node that I now have.  I just have this deep awful feeling that something is really bad with it.  Wow, I hope I'm wrong.

As for the smoking .... Believe me, I know that smoking is like the worst habit that anybody can possibly pick up.    It is absolutely HORRIBLE, and I hate it!!!   I have tried in past to stop smoking, but honestly, my heart wasn't into it.  Now, though, with this lymph gland swollen, I know that I HAVE TO QUIT!! .... I WANT TO QUIT!!!  Hopefully, I pray, it's not too late though!!!

Again, thank you for the information, and your response.  I'll make an appointment with my doctor tomorrow.

Risinghigh
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Avatar_n_tn
Well I just came from the doctor, and I don't know if it's good news or bad news.  My doctor said that the swelling wasn't an enlarged lymph gland, but instead was actually my carotid artery enlarged.  But now, we have to figure out "why" my artery is so dominant and enlarged.  I'm scheduled for a carotid ultrasound to (quote) "rule out mass vs. enlarged carotid artery."

So, that's where it stands now.  My question now is, "what would make a carotid artery suddenly become dominent and enlarged??"   I asked my doctor, but he really didn't answer the question ..... He just told me that I needed an ultrasound to get definative answer as to what we're dealing with (mass vs. enlarged carotid artery).

Should I be "more" or "less" worried???

Risinghigh
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322973_tn?1239908038
Hi,
I apologize for the delay in answering this post.
From your brief history, I imagine that your doctor felt a pulsatile mass in your neck. This can be either direct pulsations from the carotid artery (?aneurysm), or transmitted pulsations from the underlying carotid artery via a "mass" lying above it. As your doctor correctly pointed out, the first step is to confirm which of these two situations are we dealing with. An ultrasound is a good initial test, although MRI or CT angiography could be potentially more informative in this situation.
Dont worry, just get the tests done quickly. I hope you have quit smoking already.
All the best, and God Bless.

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Avatar_n_tn
Dr. Saini,

Thank you again for your response.

I actually thought about it possibly being an aneurysm, which scares me beyond belief.  My sister-in-law died of a ruptured aneurysm at the age of 20.  So as you can imagine, just the thought of that really worries me.  Yes, you definately can feel a very strong pulsatile mass in my neck.  It's not really ballooned out in one particular spot .... It's more of an elongated swelling.  I kind of checked around the internet hoping to find some kind of answer, and the one thing a did come across was a rare condition called Carotid Body Paraganglioma.  According to the different websites, one of the symptoms of Carotid Body Paraganglioma is having problems swallowing ..... which, as I mentioned in my first post, I do feel as though something is stuck in my throat, and I'm constantly swallowing.  Also, I have had a few headaches, here and there, for the last couple weeks (which are unusually for me ... I rarely get headaches).  I didn't think much of the headaches before, but now I'm starting to wonder...???...  Also I read that a Carotid Body Paraganglioma is usually non-malignant ... So I'm keeping my fingers crossed!!

Although I'm supposed to get a carotid ultrasound, I'm a little upset right now, because they didn't have any available appointments for 3 weeks.  So now I have to wait and worry!!!  :-(

Also, BTW, I've been on Pletal and Coumadin for many years.  I'm only 41 years old, but I've had numerous DVT's in my leg, and I've also had 2 Pulmonary Embolisms.  For some reason I'm always hypercoagulant.  I take a couple other medications as well, for atrial tachycardia and vascular problems.  Too much for a young adult, huh??!!! :-((

Again, THANK YOU for your response.  It helps to gather as much information and recommendations as possible.  I'll definately ask my doctor about doing an MRI or CT angiography.

Risinghigh
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322973_tn?1239908038
Hi,
One more thing that you can do (apart from the "wait and worry" bit) is to ensure that you quit smoking for good. With a history of DVT and PE, smoking even a couple of cigarettes a day is a very bad idea. Even if quitting smoking leads to stress and tension in the short term, it is still worth it. Seek professional help if needed.
I would not consider the likelihood of a paraganglioma of the carotid body just yet.
Be relaxed, be positive, and be an ex-smoker.
Good Luck!
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322973_tn?1239908038
Hi,
Also, have you had a thrombophilia profile done? Have they identified the underlying cause of your hypercoaguable state?
You may like to try for a quicker appointment at another facility if possible.
All the Best!
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Avatar_n_tn
Dr. Saini,

Again, thank you for your responses.

You'll be happy to know that this is my 3rd day of not smoking.  I know that's not a long period of time, but it's a start.  Of course, as you can imagine, I'm not a happy person right now though.  Gosh, what a horrible habit, and a horrible habit that's very difficult to stop.  Trust me, when I first had my 1st PE, I said to myself, "that's it ... I'm not smoking anymore", BUT being so young I thought I was invincible, and the smoking started right back up.  Basically, and stupidly, I've maintained that thought throughout all of my different illness.  Illnesses, that I'm sorry to say, I think are now catching up with me.

As for having a thrombophilia profile ... Honestly, I have no idea whether I've had that particular test or not.  I have had literally hundreds of blood tests though.  I have asked my doctor why I'm hypercoagulant, but he really doesn't know why.  As I mentioned before, I have a very long complicated medical history.  I've mentioned a few to you, but the list is much longer.  The most worrisome of the remaining diagnoses that may be of interest to you, is for about a year my RBC kept plummetting, and I kept having to get blood (total 35 pints).  At first my doctors were really stumped and didn't know what was causing my low RBC.  They ran tests for all the different leukemias and other cancers, but eventually they figured out that from me having to receive so many very potent IV antibiotics for a hereditary gamma gobulin deficiency, that the antibiotics somehow messed with my bone marrow ... which made my bone marrow not recognize iron, and in turn, no blood was being made.  They figured this out about a year ago ... BUT the strange thing is that every once in a while, the last being about 2 months ago, my RBC will suddenly start falling again.  Now though, it doesn't plummett near as much as it did before, and also after about 1-2 weeks, now it starts increasing on it's own, without having to receive blood.  Bizarre, huh???.....I told you my medical history was long and complicated!!!  And, also, I need to mention that with these episodes, I get these pleuritic type chest pains.  ......... And now, this lump in my neck!!   Very confusing, I know!!

So, to answer your question, "NO", my doctors have no idea "why" I'm hypercoagulant, and to be honest, they don't know "why" many things are happening with/to me.  I just keep going for tests, with no answers to follow. :-(   I am, however, going to jump on this lump on my neck thing though.  It's truly frightening me, and it's all I can think about.  I'm going to call the ultrasound department today, and MAKE them get me in there sooner.  I just feel that it needs to be looked at NOW, not in 3 weeks.

So you don't think that a paraganglioma is possible???  Why, or why not???

Risinghigh
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Avatar_n_tn
Dr. Saini,

I forgot two other things that also may interest you ..... When I was 18 years old I had cervical dysplasia, which was taken care of with cryosurgery....No problems since.  And also about 2 - 2 1/2 years ago I had a soft-tissue mass on my back/shoulder area.  They surgically removed it, and it was shown to be some type of malignant myxoid ???????? (something) --- (I can't remember the rest of the name) .  And, unfortunately, for about the last 3-4 months, the lump/mass has slowly returned.  So this, too, I need to have taken care of again.

It seems like one thing after another.  :-((

Risinghigh
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322973_tn?1239908038
Hi,
You do have a long and complicated medical history! At this point it is difficult to say anything regarding your neck swelling without a proper evaluation and a review of your past medical history.
According to your description, the mass on your back was "malignant myxoid" (??fibrosarcoma, ?? MFH). Can you pull out your old medical records and check the exact name of your back swelling? Did you get any treatment after surgery of your back swelling?
If the swelling has recurred, you need to get this checked out as well with the doctor who treated you.
Try to stay positive. It will not help to worry about all the possibilities. Once the diagnosis is made, the treatment options and prognosis can be discussed.
God Bless!
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Avatar_n_tn
Well, I still haven't been able to get an earlier carotid artery ultrasound appointment. :-(  But my doctor did call and tell me that my blood test (CBC) looked good .... Except he did say that my bad cholesteral was a little high.  Which is kind of strange because not only do I take Pravastatin, but I'm pretty much a vegetarian.....So I don't eat much fattening foods.  And also, the Pravastatin that I take was originally given to me to help with the vascular problems, not because my cholesteral was high.  I never, before now anyway, have had a high cholesteral level.

I've also now had a severe headache for the last 3 days, and I keep getting a really sharp stabbing pain that runs from my left chest area straight down toward the left side of my abdomen (right next to my belly button).....I get it with every heart beat.  I also told my doctor about this, but he just said that Pravastatin can sometimes cause these symptoms (pains). ????????  My question is, why all of a sudden NOW??  I've been taking Pravastatin for at least 2 years, so why would it just now start causing these pains???  It just doesn't seem right to me!!!  As for the carotid artery swelling .... It's still the same .... No bigger, no smaller.  I am starting to get a little tiny achy/gnawing pain on that side of my neck.  It's very very mild though.

So anyway, like I said before, I guess I'll just have to wait and worry!! :-(((

BTW, the only thing I could find regarding the lump on my back was a small hand-written note of my Internist that wrote "low-grade myxoid liposarcoma ?".  I'm not sure why he put a question mark (?) next to it. .... ????? .... I didn't have any kind of treatments for it, just surgical resection.  It is very slowly coming back though.  I'll deal with that after I'm finished dealing with this neck lump. .... One thing at a time!!!

Risinghigh
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322973_tn?1239908038
Hi,
Ideally, you should have a CT angiogram of the aorta and the neck arteries to rule out aneurysms, dissections, etc. A carotid doppler / ultrasound would also provide some useful information, though. Please discuss this with your treating doctor.
Hope you are now an ex-smoker!
Good Luck!
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Avatar_f_tn
Hello,
The other day I went to my PCP for my annual.  He was browsing over the lab tests from last year and discovered he had overlooked some abnormailities.  Those being, PTT elevated to 60 and "very high" on the liver function tests.  He wrote up some lab tests and insisted I go that very day.  He also set up an ultrasound of the liver.  I was wondering in what direction you think he may be going and what things you would or would not do.  I'm sure it's nothing, but I would like to be prepared just the same.
Thank you
Lori
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322973_tn?1239908038
Hi Lori,
The high PTT is probably because of the coumadin tablets that you have been taking. Since these report are from last year, a repeat coagulation profile would be useful. The dose of the tablets can be adjusted according to the test results.
All the best!
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