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What does my doctor mean when he says abnormal?

So you can check my other posts for more details but basically I had a ultrasound last week for a hard swollen lymph node in my neck. My doctors office called yesterday and said the results were abnormal and that i needed a CT scan. Its going to take a couple  weeks to see if my insurance will cover it. My question is what do you think he meant when he said abnormal? Like what would show on the ultrasound and cause it to be abnormal. If it's just a infection are you not able to tell if it is by a ultrasound? Basically what would the CT scan look for? I'm not trying to get perfessional advice just wondering if you guys have any insight.
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707563 tn?1626361905
Right now, "abnormal" simply means something they see doesn't look as it should. In your case, it's the lump that's there.

Usually, you have to do further testing to see if it's an infection, cancer, or what the cause it. Depending on what they see in the CT scan, they may do a biopsy, try to drain some fluid out of it to test (if it's fluid and not solid), or they may opt to go in and remove it. It's really hard to say right now, not knowing what it is.

The CT is probably going to try to determine if it's solid or liquid (a mass vs a cyst), if it's a lymph node with a growth, or something separate growing.

I know it's SO hard to wait. I'd be scared, too.


(Can you keep your questions to one thread so that everyone reading can have it all in one place? It makes for a better conversation, and it's easier for people to respond to you. Thanks!)
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1081992 tn?1389903637
"Like what would show on the ultrasound and cause it to be abnormal."
The technical terms: peripheral blood flow, unsharp border or too-sharp border, asymmetry, hypoechoic or hyperechoic where it shouldn't be, microcalcifications, anechoic cystic areas inside a node... things like that.

And loss of hilum is #1. If you post the sono report, a lot could be known. But it can be difficult for the worried and stressed patient to also be handling interacting with the doctor's office, so maybe a parent or somebody else could be your go between.

"Basically what would the CT scan look for?"
If you post the order for the CT, then we'd know what area is being scanned and that would likely tell what they are looking for. I'd guess the chest, for starters.

"If it's just a infection are you not able to tell if it is by a ultrasound?"
Yes, if the node is merely multiplying the number of immune cells inside, so that they can go and fight an infection that is outside the node.
In this setting, "abnormal" means there is some disease inside the node - but that doesn't have to be cancer, it can still be e.g. from infection that got in the node, or something immune-related called "granuloma".

This should make you feel at least a little better: if it looked really bad, they'd likely want to go straight to a biopsy -  so my guess is they want the CT to provide more clues, because things are still unsure. Hang in there, things very well could still turn out to be quite okay :)




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707563 tn?1626361905
Hi - how are you doing? Any updates?
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Hi, the CT scan came back normal but they did see a 6 millimeter node on my left lung. So I have to go do another CT scan in a few months. They said it's usually benign but they want to look at it again later.
363281 tn?1590104173
COMMUNITY LEADER
Hi, How are things going, I hope better.

In my opinion, "abnormal" means things that are not supposed to be in the area that is being examined.  Emily gave you the best answer actually.

I hope you are getting the answers you are looking for.
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Hi, things are OK. The CT scan came back normal but they did see a 6 mm node on my left lung. So I have to do another CT scan in a couple months. They said it's usually benign, but they just want to check it again later.
707563 tn?1626361905
Wow on your lung? What is the thing under your jaw?

They are doing another CT scan on your lungs to look to see if it changes in size. Keep us posted?
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"Wow on your lung? What is the thing under your jaw?"
Hi, Em. The reason that I'd said earlier that the followup CT would probably be of the chest is that the US might have suggested TB - possibly because the US showed necrosis and/or a lot of increased blood flow in the center rather than at the periphery (which more points to cancer), and/or calcification. It's a logical guess, because TB (or sarcoidosis, also usually in the lungs) can make neck nodes enlarge.

There was also no reason to suspect cat scratch fever.

But the CT didn't point to TB.
Somehow that didn't sink in at the time. Thanks for the explanation. Again. :)
1081992 tn?1389903637
For anybody who comes along in the future to read this thread: the doctor's use of the word 'abnormal' in this context is not just a casual adjective. The term has a medical meaning.

For example, from the American College of Radiology:

https://www.ajronline.org/doi/full/10.2214/ajr.184.5.01841691
"CONCLUSION. The sonographic appearances of normal nodes differ from those of abnormal nodes. Sonographic features that help to identify abnormal nodes include shape (round), absent hilus, intranodal necrosis, reticulation, calcification, matting, soft-tissue edema, and peripheral vascularity."

https://www.acr.org/-/media/ACR/Files/Practice-Parameters/ExtracranialHeadandNeck.pdf?la=en
"B.   Cervical Lymph Node Evaluation  
The  size  and  location  of  any  abnormal  lymph  nodes  should  be documented, and note should be made of any suspicious features such as calcification, cystic areas, absence of central  hilum,  round  shape,  and  abnormal  blood  flow"


Those lists are not exhaustive. They can change over time, once size was much more important. Being abnormal might require a combination of features. Also, certain nodes are naturally round.


Btw, it's wise to ask for and keep all reports, esp for tracking changes in size over time. If you post the entire US report, that makes things fairly easy - as far as trying to get an insight into what the docs would be thinking.
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