CT scan results

[madcarly]

I have rheumatoid arthritis have been on methothrexate since December and am supposed to start enbrel next week. I got very sick the first of March with pneumonia and pleurisy. I took levaquin for 10 days and I still have the pain so the doctor ordered a ct scan. I have a strong family history of lung cancer in non smokers, I have been a smoker for over thirty years. This is my second bought of pneumonia in a year and a half.

Please help me with the ct scan results. FINDINGS: numerous subcentimeter lymph nodes throughout anterior mediastinum and aortopulmonary window. This is a disconcerting configuration, but I can identify no definate lymph node of significant size. No significant pleural or pericardial fluid. A small amount of interstitial scarring is noted in the left lung base posteriorly. There is a density just behind the aorta which represents the superior pericardial recess and does not constitute a lymph node. Left adrenal gland is slightly generous in size but no adrenal mass is seen. On lung windows there is a non consolidating interstitial infiltrate in the mid portion of the left lower lobe posteriorly, acute versus chronic, mild thickening of the bronchial mucosa bilaterally. OPINION: Chronic change as described above including numerous subcentimeter lymph nodes in the anterior mediastinum and aortapulmonary window as described. No significant lymphadenopathy is identified, but there are no previous exams for comparion. Non consolidating interstitial infiltrate in the mid portion of the left lower lobe posteriorly, acute versus chronic and follow-up of this area is recommended. There is no previous exam for comparision.

I also  had a thyroid ultrasound done the same day which revealed inhomogeneous echogenicity with multiple small solid nodules scattered throughout both lobes of the thyroid gland. A nuclear medicine thyroid scan might be helpful to evaluate for the possibility of a solitary cold nodule.

My doctor has not yet called me with these results, my tests were last week. I went to the hospital and got these myself yesterday and my doctor says they do not have the results back. I am very concerned about receiving the methothrexate injections as well as beginning the enbrel next week with these findings. Please help me!

Should I be worried and further does the fact that the doctor did a lupus blood test have anything to do with these findings? The blood tests all came back as normal, no elevated ANA or DNA double strand although she suspects lupus because of the symptoms all add up to it, just not the blood tests.

[madcarly]

Thank you so much for answering. I had severe nausea and vomiting with the oral methothrexate and have been changed to Injectable. I was concerned from the stand point of having problems with my lungs because what I have read says not to take methothrexate and enbrel type meds with lung issues. The CT of the lung said facute versus chronic and follow-up of this area is recommended, so that was why I was worried. My doctor finally called last night to say I needed to come in so he could talk to about both tests but was more talking about the thyroid scan than the lungs.

Thank you so much!

[HeinrikMD]

Hi,

The presentation of multiple nodules is not the usual pattern for lung cancer in which there is usually a single mass with the lymph nodes along expected sites from this single mass.  The presentation of small nodules in a patient with known Rheumatoid arthritis makes me think more of rheumatoid nodules – the findings may well be part of the RA.
The testing for lupus is pretty standard. There are overlapping symptoms and sometimes combinations of rheumatologic diseases.
Is there a particular reason you are not looking forward to the methotrexate? is it the possibility of stomach upset?