Can someone tell me what these CT scan results mean?

[tinkydwd123]

I have a follow up with my doctor next week, but I'm trying to understand these in the meantime.  She is testing me for CLL and Hodgkin's lymphoma due to some abnormal CBC and a few other symptoms.  I do not quite understand all the medical terminology, so  I was wondering if someone could break this down for me:

Suspect incidental lymph nodes overlying the left trapezius muscle in the axial plane of the lower neck; paramidline to the left by approx 6 cm; correlation only

Prominence at the level overlying the right sternocleidomastoid in the axial plane of C5 is speculated as to likely be related to the mild to moderate mid-to-lower cervical dextroscoliosis; coincident focal duplex pattern of the right external jugular at this level noted; not a lesion

Tiny cyst midleft love of thyroid suspect; possibly a nodule

[Ken_PA]

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[tinkydwd123]

Thanks for all your info..,doc said my tests came back showing a large amount of the Epstein Barr virus, so that explains a lot of my symptoms. Platelets dropped even lower so she's going to see me again in 6 months to make sure that doesn't continue.

[Ken_PA]

Thanks for the update. You can monitor yourself somewhat for low platelets by being aware of easy bruising or e.g. bleeding gums.

[Ken_PA]

I.e., the radiologist might think the prominence is something muscular having to do with the curved neck. But that wouldn't actually be so, since the bump is movable.

Would differing leg lengths cause a neck curve? If not, then both back and neck curves could be from a CTD.

This is an interesting case, I hope that you keep me apprised with how things go. Good luck with your hema visit.

[Ken_PA]

Well, the dextroscoliosis is cervical (neck). If you happen to have a Connective Tissue Disorder (CTD), then the bump might be something like a ganglion cyst. If the radiologist knew that the bump was movable, that might have improved their guess as to what it is.

CTDs also have an association (cause unknown, though) with strange immune conditions, like Chronic Fatigue. So a CTD might tie everything together, and would be worth remembering if any quick diagnosis is not made by the hematologist.

Looking at the report again, I'm not sure what "not a lesion" refers to. The "focal duplex pattern" sounds as if that might be some artifact on the CT, and that might be what "not a lesion" refers to.

[Ken_PA]

"immunoglobulin drip"
Are you perhaps referring to IVIG? It's very expensive and not a 1st line Tx for CLL, so I'd guess the suspected Dx is leaning more toward immune dysfunction. (It's the antibodies garnered from thousands of blood donors.) AFAIK, it's kind of a shot in the dark Tx, except in special cases of known benefit.

CLL and Hodgkins need to be excluded, though.

Before any treatment, I'd want a sonogram of that bump. A sono can be superior to CT or MRI in many respects, for looking at nodes.

The nodes on the trapezius are probably a clue and not just a coincidence.

Are you aware of having dextroscoliosis? I do have a specific reason for asking.

[tinkydwd123]

I'm not sure what it's referring to...I just jotted that down as she was naming off all these things. I was aware that my spine was slightly curved, which is due to one of my legs being slightly longer than the other.

[Ken_PA]

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[Ken_PA]

Have you been under a huge amount of stress foe years? Eosinopenia is pretty rare, I'd think. Cortisol can do that.

You might be sent to a hematologist because of your unusual blood cell numbers. Blood counts can go low from a blood cancer when the cancer cells get into the marrow where normal blood cells are made. The bad cells crowd out production of the good cells. A bone marrow biopsy is used to look for that. But if both your abs lymphocytes and abs neutrophils are normal, that doesn't quite fit.

Also, it doesn't quite fit that the other counts would go low then plateau instead of getting worse and worse. Something like a toxin/poison can damage marrow then not progress, but that doesn't fit with having that bump - while an infection can both lower some blood counts while raising others, and also produce a reaction in a lymph node. But if you have no infection, then it could be an autoimmune reaction of some kind.

Plus, the CT of the bump is strange in that it doesn't identify the bump as a node. Being movable make it seem to be a node. Saying it has to do with scoliosis seems strange.

Have you had a "blood smear" done to look for the owl-eyes shape of Reed-Sternberg cells

[tinkydwd123]

It's actually a hematologist that's running the tests for CLL and Hodgkins..my primary care doctor referred me to her recently. She also said something about some sort of immunoglobulin drip as a possibility, and she was testing for that too.

I've definitely been under stress for years. I haven't gotten the blood smear done that I'm aware of (though that could be one of the tests I'm waiting to get back, since one was supposed to be specifically testing for Hodgkins).  

I'm definitely a little confused by the CT findings, and them not seeming to say much about the lump. I'm wondering if it's because it shrunk down so much while I was on the antibiotics that it looked normal again. I've been on several rounds of antibiotics since it first appeared, and it's never stayed at a normal size. It got bigger again after I stopped the antibiotics (which was after the scan). It's not huge, but it is slightly visible (the doc said it was) and my massage therapist has noticed it too.

[Ken_PA]

Besides showing the percentages, a CBC should also list the "absolute number" of cells. It's always a good idea to get and keep copies of all tests. You might have some mystery condition that will take a while to diagnose, which is of course better than having a blood cancer.

There is such a thing as a "leukemoid reaction" which is not-cancer but can make lymphocytes go pretty high, usually from some infection. A virus can also make platelets go low.

So you can look at your tests so far as intended to rule out a blood cancer. Is your bump movable?

What I'd wonder: are your frequent infections causing your unusual CBC numbers or is some defect in your immune cells causing your frequent infections? Does any family member have anything similar?

[tinkydwd123]

No family history that I am aware of. The bump is movable. I have all my labs from the last 6 years. White blood cell count has been hovering on the bottom of the range (or right below) for the last 4 labs (3.7-4.5). Platelet count has always been between 120-140 except once in 2014 where it was 183. Absolute monocytes are usually 120-150 range. Absolute eosinophils are usually under 10. Everything else seems to be in the normal range.

[tinkydwd123]

Oh, and I am fairly certain that no infections we present or recently present during at least the last two labs (I cannot remember beyond that)

[Ken_PA]

The report saying "not a lesion" would mean "not a tumor". so that's good. The tiny cyst (fluid filled thing) in the thyroid could be various things. But the bump is apparently not a metastasis from a thyroid cancer.

"antibiotics"
Some abx are also anti-inflammatory, so ether that accounts for the bump shrinking or else killing bacteria did that. Cancer would not typically react like that to abx, and also wouldn't grow and then just stop growing.

What are the absolute numbers for neuts and lymphocytes? In other words, are neuts low or lymphocytes high? I'd guess the latter because leukemia is somewhat suspected. Btw, CLL is the leukemia that is most like a lymphoma because it creates enlarged lymph nodes.

[Ken_PA]

Sorry, don't take that as being alarming. There's nothing really pointing to a cancer so far.

[tinkydwd123]

That is good to know about the lesion not being a tumor. I believe my neutrophils were in the 40-50% range and lymphocytes were a little above 50%.  Platelet count is not super low, but just hovering below the lower range at 120-130 for the last three blood tests. I get frequent infections (hence the antibiotics) and low grade fevers randomly, so that factored into why the doc was concerned.

[Ken_PA]

Okay, those trapezius nodes are probably very small and so not a big concern - though that is an unusual place to find them even slightly enlarged.. Btw, 'incidental" means the scan found them just by chance while it was looking for something else.

Next is the "prominence" which means that something is protruding. The sternocleidomastoid muscles are in the front of the neck. If you were lying on your back, they would raise your head. The "axial plane" means a slice such as when a loaf of bread is sliced. You are like the bread when lying on your back. C5 means the "cervical" (neck) bone of the spine, which is at the base of the neck. Is your bump in that same slice, but on the sternocleidomastoid muscle? The CT report says that is related to a curvature in your neck (dextroscoliosis - curved right).

[Ken_PA]

C5 = "the base of the neck" meaning where the neck joins the body. Conversely, the C1 bone = where the neck joins the skull.

[tinkydwd123]

That does make a little more sense. It seems like it does not report any findings in the area that I've had the lump. It would be about where they reference the prominent area, but there is a defined lump that even my doctor felt. My lymphocytes and neutrophils percentages are off (I have more lymphocytes than neutrophils), and my platelets have been a little low for the last year or so. I'd been on antibiotics for about a week when I got the scan, which actually seemed to shrink the lump (for the first time in a year), so it was smaller than normal for the scan. As soon as I finished the antibiotics it was back to the larger size though.

[Ken_PA]

Hi, most of those are anatomical terms that tell the location of things.
First up, can you reach with your right hand and feel any bumps on the surface of your left trapezius? If you shrugged your shoulders, that's the muscle that lifts the left shoulder.

[tinkydwd123]

Thank you for your response. I do not feel anything abnormal on the left side (I looked up the trapezius muscle and felt around, but do not feel anything). The only thing I've felt that seems abnormal is a lump on the right side of my neck. Feels like it could be a swollen lymph node, but it's been swollen for about a year.