CT scan questions

[amela321]

I am in the middle of a recurrence of papillary thyroid cancer.  I had surgery in April where a tumor and 5 lymph nodes were removed and the tumor and one lymph node were positive for cancer.  I had RAI 175mCi in the beginning of August.  

I had a neck CT scan a week ago due to a palpable lump about midway down the right side of my neck.  The scan came back suspicious for a node in that spot and also for one on the left side, both at level 2.  There was also mention of several areas of soft tissue prominence along the anterior strap muslces overlying the thyroid bed.   I will be investigating all of this further.

My question, however, is in regards to another finding on the scan.  Per the radiologist, "lung apices show patchy airspace opacities, probably atelectasis."  From my research, I understand that atelectasis is a place where no air is going through in the lung.  I'm wondering if this is something that could be caused by lung metastases.  Also, is it possible lung mets could be misread on the scan as atelectasis?  Do you feel this is something that warrants further investigation?  If so, what further testing would you suggest?

Thank you for your time,
Amy    
originally dx 1985
near total thyroidectomy and partial central compartment dissection 1985
RAI January and October 1986
recurrence dx ultrasound then FNA March 2008
Partial central compartment dissection April 2008
Tumor and one lymph node positive 2008
RAI 175mCi  August 2008
Tg of 13 prior to latest RAI

[Mark Lupo, M.D.]

Would consider a dedicated chest CT scan to evaluate lung fields.
Would look at neck with ultrasound - the strap muscles are likely swollen from surgery/RAI and not cancer, but the level II nodes need evaluation and US is better than CT for this.  FNA may be necessary.
What is current Tg?
What did the post RAI whole body scan in Aug 08 show?

I will try to follow this post.

[amela321]

The surgery was actually in April, though I didn't have the RAI until August due to CT scan with contrast in March.  Would the muscles still be swollen from April?

Tg prior to RAI was 13 unsuppressed.  The post RAI whole body scan showed areas of uptake in the thyroid bed (this is where the tumor was that was removed in April) and on the left, corresponding with the level 2 lymph node noted on the CT scan.  There was no uptake noted in the chest.  

Can the opacities noted on the scan be indicative of lung mets?  

Thank you.

Amy
Papillary thyroid cancer
Near total thyroidectomy and partial central compartment dissection Dec. 1985
RAI Jan. and Oct. 1986
FNA positive for recurrence March 2008
Tumor and partial central compartment dissection April 2008
175mCi RAI August 2008
Tg before RAI was 13

[Mark Lupo, M.D.]

A non-contrasted CT of the chest would be re-assuring to further evaluate the opacities.
The muscles could remain swollen -- neck ultrasound (by surgeon or endocrinologist) would be helpful to sort that out and guide FNA if needed of other lesion(s).

[amela321]

Thank you very much for your advice and information.  If my endo doesn't suggest that kind of testing at my next appt. at the end of October, I will request it.  

[leannlaz]

Just to update you on my problem. I finally found a hospital who would listen to me about the growth I knew was growing in my chest. Even though no ct scans showed anything. One week after I last wrote your forum, i could wait no longer. My condition had become unbarable. couldnt lean over without blood build up in chest head and neck that was awfull. I went to a teaching hospital in savannah ga. at the advice of a friend. After 3 days of extensive test. Yet my ninth ct scan was done. This time with oral and iv contrast. BINGO.... I was found to have a mass wrapped around my trachia and main blood vessels in my neck. It turned out to be second stage large cell non small cell carcinoma. I had no choice due to the location and not being able to breath, But to start radiation emediately. They wanted to do 7 weeks 5 days a week intence radiation with 7 weeks one day a week chemo. I opted for only the radiation. As I have begun a alternative treatment plan to try and clean up the cells blasted from radiation all over the place. I am one week in. And have begun to feel results. Although the water retension has caused me some problems with swelling in my upper body. mostly my face. To the point of not being able to see for the eyelid swelling. They tell me this doesnt happen to the other radiation patients. So Im kinda wondering what might be the cause. Anyway just thought i would update you...