swollen pericarinal and hilum. extensive mediastium adenopathy

[donkeytime]

I had a screening for Breast CA with MRI and it was negative, but they found mediastinal nodes. Then Helical Cat Scan which says Bilateral Apical Scarring, multiple prominent nodes within mediastinum--the largest with 18cm short axis measurement.  Prominence of right hilum worrisome for adenopathy measuring 2.4 X1.7 cm in size.   A precardinal node measuring 1.9 cm in short axis.

I have NO SYMPTOMS. What on earth could this be?  They found no cancer on the CAT, just the scarring.  After being on the internet I am afraid of metastatic cancer from somewhere(?), although I don't have any symptoms of anything.  A recent CBC was normal. I had a colonoscopy a couple of years ago--clean. My husband (RN) thinks it sounds more like scarodosis but I read that this is usually bilateral hilar enlargement.

i had posted this in lung cancer in error. The process is in the lymph system right now. Cat shows no lung nodules, effusions, etc... I know it still could be cancer but this seems to be the right place.

[donkeytime]

Thank you so kindly for your comments.   I have an appointment on Tuesday, but this is really creating anguish for me...the not knowing.  Is it reasonable to think that since I have no nodules or masses in my lungs, that it is probably not  bronchogenic cancer?  Wouldn't that metastize from a nodule or mass to the lymph system?  My lungs are clear except for apical scarring (from what, I don't know.)  I have a normal chest Xray in 2001.    I want to get the tests done as soon as I can. I am 56 and in very good health (other than the problems on the cat scan.)  I smoked for about 10 years between ages 16 and 26 but have no touched any tobacco since.    

[PaulMD]

Hi there.

These enlarged lymph nodes can indeed have several causes, and I understand your concern that this might be metastatic cancer.  Other causes like sarcoidosis may also explain these findings of enlarged nodes from no identifiable cause.  Another not so common cause is tuberculosis (if your area is endemic).

However, we have no reliable way of ascertaining the nature of these lesions except to go for a biopsy procedure.  Biopsy can be done through bronchoscopy (passing a scope to the trachea and bronchi) or through CT-scan guided percutaneous biopsy.
Possible primary cancers may include lung CA and lymphoma, but as I've said, there is no reliable way of telling this except through biopsy.

Regards.