RADIOLOGY (DIAGNOSTIC)
FORUM
LYMPH NODES
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by fish22, Apr 18, 2008
Hi Doctor,

        Last year I had a CT Pelvis w/ contrast, Examination: CT abdomen and pelvis evaluation.  I just finished treatment for HCV last month.  Test was ordered for elevated AST/ALT despite viral load undetectible.  Liver Bx done last year was not bad.  Note the following:

1)Impression: In the upper abdomen, nonspecific subcentimeter lymph nodes are noted in upper mesentery with mild infiltration surrounding porta hepatis and periceliac regions.  These findings are likely reactive.

Findings: Esophagus: Air in distal esophagus likely related to reflux. Several nonspecific subcentimeters cardiophrenic lmyph nodes.

Mesentery and Omentum: Multiple subcentimeter lymph nodes are noted in the gastrohepatic, paraceliac axis, and portacaval spaces; this is likely a nonspecific finding.  Minimal additional infiltration in the porta hepatis and surrounding the celiac axis, also likely a nonspecific finding.  There is no evidence of infiltration and/or adenopathy in the remainder of the mesentery.

Retroperitoneum: Scattered subcentimeter upper retroperitoneal lymph nodes without adenopathy.

Abdominal wall:  Bilateral subcentimeter lymph nodes.

My questions are as follows:

1) Are there any swollen lymph nodes and/or anything of concern?
2) What is subcentimeter lymph nodes?  Is this a common/normal finding.
3) Please note Impression, above. What causes mild infiltration and what is it? (lymphocytes??). What does "these findings are likely reactive", mean?
4) Mesentery and Omentum: What is, "likely a nonspecific finding", mean?  Are other parts of the Mesentery indeed infiltrated with adenopathy??  
5) Anything noted that should and/or would prompt futher investigation.

Many thanks, Doc.


Answer:
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by Anna Beattie, M.D.Blank, Apr 27, 2008
Without seeing your scans, the report sounds like there are some non specific changes ie nothing definitely suggesting a worrying disease process. It is not uncommon to see small lymph nodes and we use size as a rough guide as to whether they are likely to be involved in any pathologocal process. This however is not an absolute guarantee but can be used in conjunction with other information to assist with diagnosis or the need for further information or perhaps just to be a basis to monitor such findings, if appropriate.  

However, the reason you had the scan was to look for a cause for elevated liver enzymes and the potential list is very long and many can't be detected by imaging. It is therefore going to be the decision of your gastroenterologist as to the further management of your condition.
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