Mediastinum Infiltrate Persistant

[Kay11]

Hello,
I was hospitalized ( for one day and night   )from e.r. after abnormal lft's, wbc's, febrile, an infusion around the pericardium, and abnormal Ct Scan This is the information from past CT and the one which was taken July 14th.:

.  The impression on the first one ( May 12th ) read as follows;
1.) "Infiltration of the anterior mediastinum fat which is nonspecific.  A nonspecific inflammatory process in the mediastinum (medianstinitis ) should be considered.
2.) Borderline hilar and subcarinal lymph nodes.   This CT scan was taken on 05/12 as walked into the ER w/chest pain with deep inspiration,  febrile, chills.  My lfts were eleveated, my sed rate was 79 and my wbc's also high.

The second CT scan which was taken on 07/14 sts the following:
1.) Persistent infiltration of the anterior mediastinal fat which is non specific and unchanged.
2.) A single, borderline sized pretracheal lymph node.   Otherwise no signs of hilar or mediastnal adenopathy.

I remain sx w/chest pain, dyspnea while talking, tightness in chest on left side, pain when I reach up ( it feels like I am tearing something on the left side of my chest, h/a, afebrile, and very tired.  My lft's, sed rate, and all other blood work for sarcoid, histo, were normal.  I am not sure what to do.  Could this infiltrate lead to fibrosing mediastinitis?  Thanks for your time and information.

[Kay11]

Hello,
My bx was cancelled when I was already prepped.  The doctor told me it was to risky, as there was no safe route to the biopsy site.  I was told, perhaps, the CT scan shows residual thymus.   However, I still have the intermitant chest pain, and also pain which travels to the left side of my neck.  I was told to follow up with CT scans. At this point, I don't think I will, as I would be submitting myself to additional radiation, and there would be no clear objective. I was also told if the sx are caused by a fungus there is nothing no one can do, which I guess is true.   Perhaps, someone out there in cyberspace has some thougthts or suggestions.

[Kay11]

Hello,
I have scheduled the CT guided bx for this Friday - August 19th.  I will keep you posted of results.  I ask for your prayers and good wishes.  K

[bactitech]

That sounds like a real good plan. You need to know what's in there.

Please keep us posted as to your progress.

[Kay11]

Hi,
This is in response to note from NJC.   Yes, my lft's have normalized.  However, the infiltrate in the anterior fat of the mediastinum has bascially remained unchanged.  If it were resolving wouldn't there be some resolution to the infiltrate?  

My pulmonary physician is going to try to see if he can arrange a CT guided bx of this area.  I hope this can be done, as this is causing a lot of anxiety and frustration, and, not to mention the chest discomfort.  

Thanks for your time and courtesy.  Kay11

[National Jewish]

The cause might have been infectious, viral, fungal or bacterial.  It could have effected both your liver and mediastinum.  Since your liver function tests (LFTs) are now normal and your lymph nodes are returning to normal size whatever the cause, it is resolving.  With this resolution it is unlikely that this will lead to fibrosing mediastinitis.

You need to regularly follow-up with your doctor; about every 3 to 6 months or anytime symptoms recur.  This would be an evaluation to recheck your LFTs and CT scan.

[Kay11]

Hi,
Thanks for your information.  The web site you referred to: http://petcaretips.net/bird-disease-transmit-human.html I cannot bring it up, I cut and pasted it to the search engine Yahoo. Perhaps I will try again in a couple of hours.
My husband has a pet parakeet, which he has had for several years.  It is hung from the ceiling in our kitchen.  I am not fond of having the bird kept close to where we eat, however my husband doesn't believe that there is any health risk.  Is there a risk? We have had this talkative bird for about 5yrs.  

I did have a blood test done for histo, but no one did any tissue cultures.  The blood test was as follows:   Histoplasma, ABS cf Histo Mycelial Phase.  <1.8 results    Reference range:  <1.8 Histo yeast phase 1:8.   However, I believe there is a different test that can be done - with the blood - is that correct?    I also did a urine sample, which was also negative.

No, I have not seen an infectious disease doc, as none of the physicians seem to think it is necessary.   Perhaps, I should self refer myself.   I believe at this point, no one seems to know what to do, as the sx and CT scan do not apply to any specific disease.  However, having an infiltrate in the anteroir mediastinum, which has remained unchanged is very unsettling.
My daughter has a May wedding planned for next year, and I would like to be asx well before that time, so I have the energies to actively involved in the excitement of planning her wedding.

With kind regards. K

[bactitech]

Have they run any sort of cultures for Histoplasmosis? Did you have titers for Histo? I assume that's what you mean by blood work.

You could have some other type of fungal infection going on. Bird/bat feces are notorious for these type of infections.

http://www.crittercontrol.com/birddiseases.htm

http://petcaretips.net/bird-disease-transmit-human.html
(make sure you check on this page for sure)

Have you talked to an Infectious Disease Doc? If not, I would see one ASAP, especially with the symptoms you have, and after reading the second page posted above. Is there talk of any type of biopsy? If so, cultures for fungi should be included. I know there are other titers that can be drawn.

I'm a clinical microbiology med tech with 31 years micro experience.

Good luck. Keep us posted.

[bactitech]

Without looking at a reference lab directory I couldn't begin to speculate on the myriad of blood test titers that are available. The urine sample also could have been tested for many things. Most outsiders don't have any idea how vast a laboratory test menu really is.

You have a number of risk factors. The fact that you have an infiltrate bears some investigating. Maybe it's because I work in microbiology, but I've found that ID docs are very thorough in their investigations, and can come to solutions much faster than other docs, as they're much more aware of possible infectious factors. They are trained as internists first, and then take a specialty in infectious disease. They are puzzle solvers. If I were you, I can see nothing to lose in insisting on seeing one.

Try this link for the second website:

http://tinyurl.com/7zfvr

Keep us posted.

[Kay11]

Addendum,
Hi,
I forgot to add the following information.  I am a 57yr old and normal weight and height.  I am very active.  I did smoke from the time I was 18 till about 24.  I then quit for approximately 25 yrs or so.  I started smoking again when my daughter had a life threatening eating disorder, and my mom was dx'd with Alzheimer's.  Mom recently passed away.  My daughter is doing great!    I smoked about a pack a day for a year or so.  I now smoke 1-2 a day, on some days none depending on the stress level at work.  
I mention the histo in my first note, as we have a large farm pond, any my son was excavating a site for our gazeebo.  I also have a bat house near by.  The ground he was digging is shady and moist and has a very noxious odor.  There are black-birds and starlings that roost in the trees.  I became sx about 10-14 days later.  My son is fine, although he did have a cough for about 2-3 weeks.  We live in an area where histo is common.

This situation is causing alot of stress, for myself and family.  I have sought the opinion of two pulmonary physicians.  One of the pulmonary docs thinks I should do the mediastinoscopy.  The other does not.  I also took my CT scans to a thorasic surgeon who did not show any concern, except to advise to do another CT scan, which I did do.  I am awaiting his reply.

I would appreciate any information that anyone has to offer.