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Primary Care Ordered CT Scans But Gave No Answers
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Primary Care Ordered CT Scans But Gave No Answers

Help! PCP ordered CT and blood work. Dismissed me. Very ill since November '12. Please let me know what you make of the following findings from my recent tests, what sort of diagnosis I'm facing, and what specialist to seek out for help. Thank you. 1) discrete mass from the cutaneous surface of the face is not identified2) discrete mass from the laryngeal or pharyngeal mucosa is not identified3) numerous reactive cervical lymph nodes are identified without definitive pathologically enlarged node based on CT size criteria4) scattered sub centimeter low attenuation thyroid nodules. Ultrasound may help to allow further characterization5) extensive pansinus disease is identified (mind you, I was on 2 antibiotics during this test and I have no indication of sinusitis with exams)6) 3-4 mm Lucent lesion surrounding thin sclerotic rim within T3 vertebral body7) few small lower cervical chain nodes are present8) minimal bronchiectasis identified in the anterior right upper lobe branch, nodules in the deep left sulcus, patchy atelectasis anterior/inferior right upper lobe9) blood results show high CEA, high Alpha-2 globulin, high sed rate, very high NEU (ANC), high beta-2 Microglobulin, high ANA
My major concern is my blood test results combined with the CT findings and my severe weight loss (30 lbs since January 2013) and the incredible pain I'm battling... Why would someone dismiss the above findings? Are they not indicative of any sort of disease? When they say that the masses are "not identified", what do they mean? What are reactive lymph nodes? Do my blood test results point to anything?
I am obviously sick. I think it's horrible that I've been dismissed by my PCP with no answers. Please help me understand what the above results mean and where to go from here. Thank you!
4610897_tn?1393869202
Thank you for your question. Without being able to review your entire history it will not be possible to give you an exact answer, but generally speaking I can describe some of the terms used in this report.

I cannot speak for the interpreting radiologist, but it is very possible the ordering physician may have wrote something like “please evaluate facial mass/pharyngeal (throat) mass” that your physician may have seen on physical exam. If they could not see them on the CT scan, a radiologist will often write something like “mass not identified”. So this item does not necessarily imply a pathologic finding - just they didn't see something on the CT scan that they were told to evaluate or saw on another imaging study. Reactive lymph nodes are the term to describe a lymph node that is enlarged due to a “reactive” process like upper respiratory infection as opposed to something like lymphoma, which isn’t benign. The CT scan reports that this node does not reach “pathologic” criteria for lymph node size c/w malignancy per se. Reactive lymph nodes that don't go away or get larger or are not explained by any infection, etc are often biopsied. An ENT physician often performs these evaluation.

Thyroid nodules are often evaluated further with thyroid function tests (blood tests called TSH and free T4) and an ultrasound of the thyroid. Pansinusitis or sinusitis is not an uncommon incidental finding in patients undergoing CT scans of the head and neck.

Bronchiectasis refers to destruction of the airway, an irreversible dilation of the bronchus, a part of the airway. It is associated with a wide range of disorders, but most commonly from bacterial that are known to cause pneumonia and bronchitis. Atelectasis refers to lung tissue that is not fully expanded or is collapsed.

Sedimentation rate or ESR is not a nonspecific marker of inflammation. ANC or absolute neutrophil count is a type of white blood cell that is often elevated in the setting of infection/inflammation or acute stress. CEA is carcinoembryonic antigen and is used for determining the extent of disease and prognosis in patients with cancer (especially GI or breast). Not sure why this would have been ordered in this case, and the significance of it being elevated.

Alpha 2 globulin may have been obtained in the setting of protein electrophoresis. The protein in the blood is a combination of prealbumin, albumin, and GLOBULINS. The globulins are subclassified into 3 main groups: alpha, beta, and gamma. Alpha2 globulins include serum haptoglobins (bind hemoglobin if it is broken up or hemolyzed), ceruloplasmin (carrier for copper), prothrombin (a clotting factor), others. In some diseases, albumin is selectively diminished and globulins are normal or increased to maintain a normal total protein level. Alpha 2 globulins are increased in acute infections, tissue necrosis, burns, surgery, or stress. It is NONSPECIFIC. Increased beta globulin levels may be seen in hypercholesterolemia (by itself or in association with biliary cirrhosis, hypothyroidism, or nephrotic syndrome (condition where kidney loses protein)).

Antinuclear antibodies (ANAs) is found in systemic lupus erythematosus (SLE), systemic sclerosis, inflammatory myositis, and Sjögren's syndrome, and is required for the diagnosis of some syndromes, such as drug-induced lupus. It is non-specific, but abnormal.
A rheumatologist would be the next physician to see given the abnormal blood tests and “constitutional symptoms” of weight loss/malaise, pain, etc.

I agree that these abnormal findings should be followed up further. A referral to a rheumatologist would be appopriate in a patient with similar findings.

Very Respectfully,
Dr. S
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