Anxiety regarding CT Scan

[BeamerBoy]

CT scan results: Central airways are patent. Heart is normal in size. Minimal pericardian fluid versus thickening. Pleural spaces normal. Minimal bilateral apical pleural-parenchymal thickening with no evidence of discrete mass or nodule. Likely post infectious or inflammatory in nature. Subpleural nodule identified in left lower lobe.  Could represent volume average from posterior aspect of ipsilateral hemidiaphragm insertion. Possibility of subpleural parenchymal nodule cannot be excluded. Lungs are otherwise unremarkable. Evidence of splenomegaly.  Small, approx. 7.6 mm in diameter low attenuation lesion is identified in spleen too small to characterize. Small splenule in left upper quadrant. Regional osseous structures demonstrates no evidence of progressive lytic or blastic lesion.  
Could you decipher this for me?  Thank you.

[RCA7591]

What was the indication for performing the chest CT scan?

More importantly, how do you feel? What's wrong?

" Lungs are otherwise unremarkable."

^quote

That is all you need to know. Ignore the other jazz.

"Evidence of splenomegaly."

^quote

Any history of blood disorders? Thrombocytopenia (platelet count less than 150)? Red blood cell morphology, bone marrow morphology, or platelet morphology (large or abnormally shaped platelets) are the usual suspects in the case of Splenomegaly (enlarged spleen). The other major contributor is autoimmunity.

Spherocytosis, Alpha/Beta Thalasemmia Intermedia or Major, Lymphoma, Leukemia, Polycythemia Vera are the more common etiologies.

Inflammatory processes (acute infection, Sarcoidosis, Amyloidosis, Lupus, Mixed Connective Tissue Disease, Scleroderma) and other autoimmune diseases may cause Splenomegaly.

Since a host of processes could explain the Splenomegaly, I once again must ask "how do you feel"? Do you have copies of laboratory work (if applicable?)

I'd be looking at increases in Bilirubin, Albumin, Alkaline Phosphatase, Total Protein, a decreased Hematocrit, a decreased Hemoglobin, decreased MCV and MCHC, and a low platelet count (less than 150,000). Liver function tests (AST/ALT), BUN, and Creatinine would also be helpful.

Should these prove to be within normal limits (including the WBC count and differential), I would suspect autoimmunity. Among the top three picks would be Scleroderma, Antiphospholipid Antibody Syndrome, and SLE (Lupus). A good start would be to request an ANA titer w/pattern, the Lupus anticoagulant, and Anticardiolipin Antibodies.

Ryan