CTC Results

[Amorty]

Hi, I will try to provide a brief history/background.  40 yr old male, was diagnosed with Diverticultis at 28 (young I know).  2-3 attacks a year.  My disease is apparently advance/severe i.e many many tics mainly in the sigmoid but a good handful in the decsending colon.    Dec, 2008, CT with triple contrast, shows Bowel wall thickening with evidence of inflammatory changes in the sigmoid mesocolon.  Evidence of mild fatty haziness, and multiple enlarged lymph nodes in the mesocolon.  No evidence of abscess formation at this time.  Only recommendation from the Radiologist back to GI Spec was for interval endoluminal evaluation.  CT 1 year prior was very similar but with no finding of enlarged lymph nodes.  
 July 2nd, 2009, CTC along with 2d imaging to help with 3d findings.  Note, prep was deemed to be moderatley  well prepared and distended.  Same liver lesions in segment 4b detected as last ct, no change.  Remainder of imaged solid organs are within normal on this none contrast study.  Left Inguinal hernia and Hiatal Hernia found.  I knew about the Inguinal hernia...the other was new to me.  Sever diverticulosis in the sigmoid colon with marked mural thickening.  There is hyperemia of the sigmoid mesocolon with adjacent adenopathy measuring between 7-8mms in short axis.  No other focol colonic leasions is seen.  
The thickening, luminal narrowing and even the hyperemia he said were in keeping with on going diverticulitis.  
The presence of adenopathy was somewhat concerning to the Radiologist.  Radiologist suggested CT for needle based biopsy.  My surgeon said we should do this in early October.  He didn't seem to panic and said October would be fine..  Current symptoms, gas, more frequent bowel movements (no infection), stomach is making lots of noise (not all the time but fairly frequently.  Some upper stomach noise and discomfort.   Please let me know your thoughts.

[Amorty]

Hi thank you.  Can chronic inflammation be a cause of the enlarged nodes.  With no other evidence of lesions and the fact that the enlarged nodes were noted 7 months ago is more or less likely it could be cancer.  

[Kevin Pho, MD]

I agree with the tests done and the general approach.

The adenopathy needs to be further evaluated to exclude cancer, specifically a lymphoma, and the biopsy would be the best way to do that.  I can't comment on the time frame, but if you're concerned that it isn't done soon enough, you can obtain another opinion.

Regarding the hiatal hernia, they are not normally surgically addressed, unless the symptoms become severe.  Typically, reducing acid with a proton pump inhibitor is recommended.

These options can be discussed with your personal physician.

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd