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Avatar universal

lung nodule and inflammed lymth nodes

I am upset over the lung biopsy I had last last month.  First one dr tried bronchoscopy/endobronchoscopy and couldnt or didn't get enough samples....3 week later surgeon did bronchscopy then had to do the mediastinoscopy and did get samples of the lymth nodes but did not biopsy the nodule....surgeon said they were the same and he didn't need to biopsy.   New Pulmonary doctor said the nodule and the lumth node problem could be unrelated.  We are trying to figure out what infection I have been exposed to and if it is active.  He is lookiing at histoplasmosis orTB....I can't take skin test because I test positive so he has rdered a tb blood test and a histoplasosis urine test....both take 8 weeks.  I will have a ct scan in Oct to see if either has grown.    So the thing I wonder is  will the culture that was started on July 17 from lymth node tissue give us our answer.  Also the stain report fowarded from the surgeon showed no fungi present...?...yet he told me my diagnosis was Casseating granulomous and it was a fungi like infection like tb and histoplasmosis.  I have been exposed to pigeon poo dust for a period of 9 months from sept to may of this year at the place of employment..  I also took medication when the skin test came back positive  for tb but did not have active tb.  I do have asthma and a touch of copd.   So unless I have symthods or we get the culture results back we are waiting and watching.   So do I have an active infection with the lymth nodes being inflammed.   Is the nodule likely the same as the nodes?
6 Responses
Avatar universal
MEDICAL PROFESSIONAL
Hello and hope you are doing well.

The mediastinal lymph nodes are not usually visualized on an X-ray or a CT scan unless they have been enlarged. This enlargement of nodes can be caused by chronic infections like tuberculosis, sarcoidosis, lymphomas, leukemias and due to occupational lung diseases like silicosis, asbestosis etc., these nodes enlarge due to a problem in the lymph nodes per say like lymphomas or secondary to a problem in draining area of lymph nodes.

As you are in the process of ruling out other conditions, next you could see if any of the draining areas have any evidence of infection, like tonsils, the skin, tooth abscess or an ear infection. Infections like tuberculosis can cause lymphadenopathy.  It would be worthwhile to see if other lymph groups are enlarged namely, axilla and groin, these can be palpated, the others like those in the chest or abdomen may need a CT to detect their enlargement. Also correlate with blood counts, this could lead to further analysis.

Hope this helped and do keep us posted.
Avatar universal
Thank you for replying.  i was really upset that the Dr. had not biopsied the nodule when he did the lymth nodes.   I wasn't comforted by him telling me they were probably the same thing.  I didn't doubt the pulmonary dr since I felt the same way.  I just don't understand why he wouldn't.  I was under the impression it was close to the lymth nodes.  I know they check the lymth nodes around the neck area and they weren't inflammed.  The TB test came back negative.  A relief.  The biopsy culture should be back soon  and I hope that tells us something.  As you might image it's the waiting and wondering that is so hard.  My tonsils are gone, no skin problems, and the dental appointment two weeks ago told me everything was great.  Nice healthy gums.  Which ended up bleeding the next week since my blood was toxic...4.6....they have been working on that since June.  I thought sarcoidosis was non caseating glamulomous..?  My glamuloma was caseating.  Ears is something no one has asked about.  Blood counts is something I haven't asked about.  I haven't heard anyone say anything about a raise in white blood cells.  Wouldn't they be higher if I have a infection?  I feel bad for the new pulmonary doc getting it dumped on him.  At least I don't have any concerning coughs, fever, weight loss or anything that screams alarms.  Thanks again for your reply and willingness to listen.
Avatar universal
MEDICAL PROFESSIONAL
Hello and hope you are doing well.

Yes, blood cells could add up to making a diagnosis. Increased ESR, elevated lymphocyte count and a caseating lymph node all go in favor of tuberculosis. Sometime when there are conflicting reports a diagnosis is elusive. But the biopsy may help to clinch the diagnosis. Good Luck.

Hope this helped and do keep us posted.
Avatar universal
Biopsy cultures all came back negetive.  I am still waiting for a culture the pulmonary dr. started on histoplasmosis to come back the first of Oct. and then I will have another ct scan to see if anything has changed with the lymph nodes or the nodule.   TB test blood test was negative.   If everything comes back negative that has been done and the lymph nodes is still swollen will they need to run more tests?   If the lymph nodes are not swollen .....will they be done......are should it be checked in six months with another ct scan?  Other scan was done in June for heart ablation doctor and the swollen lymph nodes and nodule were discovered then.  An the nodule...could the surgeon really know it was the same thing since it too would appear cheese like in appearance?  I guess I worry about it because of the smoking history I have and he was aware of before the procedure.  Thank you so much for your reply.
Avatar universal
MEDICAL PROFESSIONAL
Hello and hope you are doing well.

Understand your predicament. But please don't worry. If all the test results are negative, then a follow up is mandatory to study the changes in the nodes and the nodule. Also, the basis for this will be based on the development of your symptoms. So, keep a watch on your symptoms and follow up regularly. Also, don't neglect your health, take a balanced diet and sleep well. Best Wishes.

Hope this helped and do keep us posted.
Avatar universal
Hello,
Well I am still doing well with the lung thing.   I have been checking with lung doc every four month, still symptom free.   However, we accidently discovered another nodule.   I had a knot on my neck that worried me and my regular doc ordered a ultra sound, which didn't show anything on the knot but did show a 1.8 cm nodule on my thyroid.  They send me for ct scan, which should have been a T134.  Because of the contrast with the first ct test, I have to wait 8 weeks to be retested with the correct test.   I did have the lung doctor notified and had a regularly scheduled appointment last week.  Now he is going to do another scan in May to be sure everything is alright..   When I told him about the new nodule, he asked if they sent me to a Endocrinologist, and I said no a surgeon.   So I am from a small town and all the doctors know each other, so do you think that was a hint that I should.  He also asked when the correct test was scheduled and I said they haven't scheduled it and he made a point to schedule his ct scan before I left his office.   Should I schedule with a Endocrinologist?   I do have some symptoms for under active thyroid, two sisters on thyroid meds, two nieces, and a aunt.  My father had a pituitary gland tumor.  Plus I feel like they should have checked the function of the thyroid but no has bothered.  I know that having a nodule on the thyroid is common, mostly not cancerous but with one nodule being watched it still makes me nervous.  The surgeon said he hadn't ever heard of lung nodules moving to the thyroid but it doesn't mean it couldn't happen.   I understand the difference between hot/cold on the scan and also understand even if its cold it may not be cancerous,  it may be checked with a needle biopsy if it doesn't appear right.  If I was a close relative of yours, what would you tell me to do?  Wait it out or get  Endocrinologist?  Or request that they test the hormone levels, tsh,T3 and T4.....since I know two people that had ok tsh but when they finally tested the T3 andT4 they found the problem.  Any help you can give me would be appreciated.
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