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Thursday, December 12, 2013
My 83 yr old mother was recently hospitalized with fluid around her lungs and heart. She is now home and just received CT Scan results. Small lympth nodes in the mediastinum. With an elarged subcarnial node measuring 2.3 x 1.7 cm. In occludes a small calcifrication. Small calcified lymph noes are identified in both hilar regions. There are multiple lymph nodes identified at the level of the GE junction , the largest is 1.6 X 1.5 cm, and has a low density centre. The family doctor gave her an option of going for a biopsy or waiting to redo the CT scan in three months. She is still very weak, coughing and has laboured breathing. Do I push her to go for the biopsy now ? /thanks
You mentioned that she has calcified lymph nodes. A calcification in the lymph node usually means that it is not cancer and could be from a fungal infection or another condition known as sarcoidosis. However, if she has fluid around the lungs and heart, that is also a concern when she has labored breathing and this could be from cancer unless she is malnourished. The fluid can be caused by poorly functioning heart or infection or even cancer. I am not sure what her functional status is, if she is active and can withstand a procedure then it is worthwhile to get the biopsy. You did not mention any abnormality in lungs itself.
One option would be to drain the fluid around her lungs and send the fluid to lab to see if the fluid is caused by any cancer or infection or heart or get a referral to see a pulmonary (lung) specialist.
Another option, as your family physician recommended is to wait for a 3 month follow-up CT to see if the lymph nodes are getting bigger in size.
If she is strong enough, the biopsy of the lymph nodes can be done with a bronchoscopy under moderate sedation, by a procedure called TBNA (Trans bronchial needle aspiration) of the subcarinal and/or hilar lymph nodes. This is a less invasive way of getting tissue from the lymph nodes and there are chances that good diagnostic tissue may not be obtained. A rather definitive technique would be to do a surgical procedure in the operating room called mediastinoscopy under general anesthesia which has a better chance of obtaining good tissue but has the associated risks of surgery and general anesthesia. However, from your description I don't think that she would be a good candidate.
She may also benefit from an echocardiogram (ultrasound evaluation of the heart) to see if poor heart function is causing her shortness of breath or fluid to appear around the lungs.
Please let us know if you have any further questions.
Shaheen Islam, MD, MPH
Clinical Associate Professor
Pulmonary, Allergy, Critical Care & Sleep
College of Medicine
The Ohio State University