Chest X-ray and Biopsy

[TSG]

Hello,

Last week I had a chest x-ray that showed a mass near my heart (paratracheal area).  After a CT Scan and Biopsy they stated all the lymph nodes in that area were swollen.  I finally got the word today that they found non-caseating granulomas which the doctor said wasn't found in Lymphoma.  They are now looking at some sort of infection and I was wondering if you had come across anything like this before or had any idea what it could be?

Dry cough, chest pain and heart palpatations (sp) are some of the symptoms along with burning and itchiness near the sternium and under the arms (some of the time).  No other lymph nodes are swollen though.

I have had an angiogram and ekg which is all normal, so they said it's all related to the swollen lymph nodes.  I did have a sinus infection just before this all started, but it all went away.



Thanks for any advice!
TSG

[National Jewish]

Non-caseating granulomas are seen with sarcoidosis.  This is a disease that causes small clusters of inflammation, called granulomas.  The granulomas can occur in any area of the body, but are most often found in the lungs, lymph nodes, eyes, and skin.  Typically sarcoidosis effects only the lungs.  When sarcoidosis effects the lungs, it can cause enlarged hilar lymph nodes that are in the upper middle area of the lungs.

Non-caseating granulomas can also be seen with hypersensitivity pneumonitis (HP).  HP is inflammation of the air sacs of the lungs.  This is caused by an allergic reaction to inhaled biologic dusts that are small, 5 microns or less in diameter.  Biologic dusts include animal or plant proteins, microorganisms, and rarely low-weight chemicals such as isocyanates in automobile paint.

Your doctor is right that non-caseating granulomas are not seen with lymphoma.  Usually tuberculosis (TB) granulomas are what we call caseating.

If this is sarcoidosis, it could involve your heart and other organs.  Ask your doctor about this.  Your doctor might want you to see a lung specialist.

[LukeL]

I just read an article on your condition and the good news is that your lungs and heart and CNS are not effected this presents with higher rates of complications. Also may I ask are you African-American because the ration of blacks to whites is 10-20:1.

Here are some articles you may want to read don't be alarmed though because each case is different. The material may be a little bit technical and advanced but it should provide you with some much needed info.

http://www.emedicine.com/emerg/topic516.htm
http://www.emedicine.com/DERM/topic381.htm

[TSG]

Hello LukeL,

No, I am caucasian male age 35.  I know...I've already been told that the ratio of white males getting this is 1:100000, so I'm supposed to feel special.  HA!

I think I've read EVERY article about Sarcoidosis known to man...even have those you sent me bookmarked.  :)  I work at a University and have talked extensively with the Doctors/nurses here and they say it's a very treatable disease (not curable), but the fatality rate of it is next to zero unless it's stage IV and very late in the game.

According to my Chest X-ray the lungs and all are clear, just the paratracheal area lymph nodes are swollen, so they consider it Stage I and will problably starte me on some medication/steroid to get the inflammation down.  I do have the dry cough, burning in the chest and shortness of breath, but they said it's due to the number of lymph nodes that are swollen.

Thanks for the info and I'll keep you updated.

TSG

[LukeL]

I have never heard of this but I do know that granulomas are caused by infection or irritation to a particualr part of the body.

[TSG]

Well I got the pathology report and it came back that I have Sarcoidosis.  My lungs aren't affected, just the lymph nodes around them.  All the tests for fungus, bacteria and viruses were negative.

NOW what do you do?  The doctor is sending me to a pulmanary specialist next week for further work ups.  

Anyone know what I should expect?

Thanks in advance!
Shayne