Scared

[Mich1111]

I had a cat scan of the abdomen and pelvis yesterday. I have mild anemia and my gastroenterologist is doing a colonoscopy and gastroscopy in addition to the cat scan.

The cat scan showed these findings:

FINDINGS: Focal area of bowel wall thickening in the ascending colon (series 2 image 50) could be physiologic, although colonic neoplasm cannot be excluded from this appearance. This finding was not present on the previous exam. A mildly enlarged and several mildly prominent mesenteric lymph nodes are noted in the right lower quadrant, which have increased slightly in size since the previous exam. For example, the largest mesenteric lymph node in the right lower quadrant (series 3 image 27) measures 1.5 x 1.1 cm, and is increased slightly in size. No bowel obstruction. A few sigmoid diverticula are noted, without evidence for diverticulitis. No bowel obstruction. No free intraperitoneal air or fluid. The uterus is not seen, consistent with history of prior hysterectomy. Prior cholecystectomy. The spleen, adrenal glands, pancreas, and kidneys are unremarkable. No hydronephrosis. The lung bases are clear.



IMPRESSION:



1. There is a focal area of bowel wall thickening in the ascending colon. This finding could be physiologic, although colonic neoplasm cannot be excluded. Please clinically correlate. Consider colonoscopy for further evaluation.



2. Mildly enlarged mesenteric lymph node in the right lower quadrant, with scattered mildly prominent right lower quadrant mesenteric lymph nodes have increased slightly in prominence since the previous exam.  

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I am scared I have colon cancer. I do not understand why the radiologist went from saying it could be physiologic or neoplasm. How can it be one or the other? That doesn't make any sense to me.

Also, I have had mesenteric adenitis before. I have IgA Deficiency but never has a report singled out just one lymph node like that, I am not sure why.

I don't understand why the radiologist didn't say if it was regular or irregular thickening either since that means something. Since he didn't say does that mean it would be regular thickening?

My gastroenterologist today told me he's actually not very worried. He said if he had a dollar for every report that comes back with this finding and it was nothing serious he'd be rich. He said it's very possible my colon was spasming during the cat scan and that's why it gave that certain appearance and the finding is nothing. He will do the colonoscopy on April 30th.

Questions:

1. Do you know why the radiologist wouldn't list what kind of thickening it was, regular from irregular?

2. How is it possible that the radiologist said it could be physiologic OR neoplastic? How can it be one or the other?

Thanks.

[Mich1111]

Intestinal TB interests me... I have had an upper respiratory infection that will not go away. I've had it since March 11th. I've been to the doctor twice who said my lungs were clear and thought it was in my sinuses. Today, I feel like a wheezing in my throat area. Not lungs but throat area.

Could this upper respiratory infection combined with the cat scan intestinal findings indicate abdominal TB and if so, how will it be found?

Also, I am very scared about malignancy. My GI on the phone seemed to think the mesenteric andenitis and finding in the ascending colon was separate and he wasn't concerned about the mesenteric adenitis. I love this doctor but why isn't he concerned about the adenitis?

I want this nightmare over with. I want a diagnosis.

[Bhupinder Kaur, MD]

Hello,
Mesenteric lymphadenitis is an inflammation of lymph nodes caused by mostly infections an given your medical history it may be due to this condition only. But considering your report infections like tuberculosis abdomen and any malignancy should be ruled out. All diagnosis are not clear from imaging methods like CT scan because the bowel may be shadowing the lesion and moreover with histopath tests one cannot confirm it. Hence you should follow your doctor’s advice and get a colonoscopy and colongoscopic guided biopsy of the lesion and lymph nodes done along with tumor markers in blood to confirm the diagnosis.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[Mich1111]

I talked to my primary who also said she wasn't totally concerned. She said if a neoplasm is there, colonoscopy will find it but she thinks it's "highly unlikely" and to not lose sleep over it. That was her email response.

Why is that? Why is the gastro and primary not too concerned? I don't understand given what the report says. Though I am not a doctor and medically trained to read these things either. I am just confused and scared.