Pneumonia with mediastinal lymph nodes.

[tommydorns]

Hello,

32 year old male, former smoker
I smoked for 9 years and I quit 5 years ago

Went to the ER about 6 weeks ago with severe back pain that went to my chest. At the time, no other symptoms.
Had a chest x-ray that showed abnormalities so they did a CT scan of my chest. Suspected pneumonia with lymph nodes swollen in my chest and one in my upper abdominal area. Negative for nodularity. Was given 10 day course of Doxycycline. Was told to follow up because of lymph nodes. Differentials include Lymphoma, Sarcoid, and Lupus. Went to the follow up. The Dr consulted a well respected pulmonologist who said to wait as this could have been caused from infection for the pneumonia. Repeat CT in 6 weeks. I also started coughing up blood tinged mucus at that time which has went away along with the plerisy pain. Of course I'm freaking out researching and I can't find a single case online where this happens with pneumonia. It's always cancer or Sarcoid. So I have repeat CT 5 weeks later, the pneumonia was still their although greatly improved and lymph nodes are still there although every one of them have shrank at least a mm. One shrank 6 mm. The Dr isn't going to worry about biopsy or anything. He is going to see me in three months. I'm still wondering about this. Had anybody ever been through or heard of this and I'm worried as to why the nodes hasn't completely gone back to original size after almost 6 week and pneumonia is still lingering. I still cough up a little yellow stuff every once in a while. What should I do...

[ayl291]

Get another opinion and biopsy, is my opinion.  Those are two very different conditions with two very different treatments!!

[tommydorns]

Thank you for your reply. So you don't believe the lymph nodes are there as a result from pneumonia? I will seek out a second opinion.

[ayl291]

Look here is the thing.  I'm a nurse and have seen awful misdiagnosis.  The reason I'm here is bc I was personally misdiagnosed for 3 months.  I walked around with pulmonary embolisms ( deadly) and was told to ignore it and I was fine.  Now 3 years later I have damage I'm trying to repair.

My uncle is actually dying bc he was also told he had pneumonia and it ended up being lymphoma.  It has not spread to his brain.
He would have been fine if they had diagnosed at the right time.  As would I.

So, long story short, it could be nfrom pneumonia.  But I don't want someone else ****** over.  I would totally get it biopsied to have a 100% clear answer.

Let me know if you have any questions, I hope I didn't freak you out.  I was just sharing.

[tommydorns]

Thank you for your input. I am really curious if this is a common clininal finding on a CT scan with puemonia. It's weird because the nodes are shrinking with the puemonia getting better on the repeat CT scan. I am going to take your advice and push for a biopsy. I don't have enlarged lymph nodes anywhere else. Sorry to hear about what you have been through.

[tommydorns]

Actually I am going to request another CT scan in 3 months before I go for a biopsy. With pnemonia getting better and my lymph nodes shrinking and I did have pnemonia with symptoms that are now gone. The procedure is kind of risky and invasive. I will wait 3 months and see and possibly get a second opinion first. Unless I start getting sick or start having night sweats or something then I will proceed immediately. Malignant nodes usually don't shrink unless treated specifically. What were you initially diagnose you with. Did they not do a repeat chest x-ray or CT with your uncle?

[ayl291]

They did ... Said they were shriking as well.  I looked and they looked the same to me.  The first chest cta I had completely missed my pulmonary embolisms.  

Radiology is more subjective than you would think.  

Accuracy rates are usually in the 70 percentiles.

But I completed get your hesitation.  

Maybe at least get a reread of the scans?