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Hello, my name is Thomas. I am 32 years old. I am Caucasian and a male. Ex smoker of nine years. I quit five years ago. I am going through steps on getting a diagnosis. Brief history on what's going on.
I am a Pharmacy Technician in a hospital and while I was working back in June 2018, I started getting really sharp pain underneath left shoulder blade that eventually got extremely painful and went to my chest, especially when inhaling/exhaling. I ended up in the emergency room. They immediately suspected pleurisy. They took blood and a chest X-ray. Chest X-Ray showed was completely abnormal. Showing Bilateral filling in hilar as well as enlarged lymph nodes in mediastinum. As well as a airspace opacity in my upper left lobe. After they did A Chest CT with contrast that confirmed bilateral lung infiltrates with ground glass opacity, lymph node enlargement in the hilar, mediastinum, and one in the gastrohepatic area. Specific nodes noted was, right paratracheal, subcarinal. The largest one measured 2.5 CM.
They suspected pneumonia but said other things couldn't be ruled out (HIV, Tuberculosis, Lupus, Lymphoma and Sarcoidosis). I started a 10 day course of Doxcycycline After a follow up they decided to do another CT with Contrast in 5 weeks to see if there is an improvement. Blood was ran to rule TB and HIV which both were negative. ACE was done which was 41 which is considered in normal range. LDH was 210 which was also in normal according to the labs. A day later I started bringing up mucus with blood in it. After finishing the antibiotic both the mucus/blood and pain went completely went away and has not come back which made me think I actually did have an infection. The 5 week repeat showed improvement in the main infiltrate in the upper left lobe and mild improvement in the other infiltrate in the other lobe. Some of the lymph nodes shrank 2-3 MM. The one that measured 2.5cm was now 1.9 cm. This scan showed some borderline spleen enlargement though. My GP was done with it even though resolution was completely there.
I decided to get a second opinion with a pulmonologist. He decided to do another CT in another 5 weeks. This scan, according to the radiologist showed no change however the lymph node noted was 2mm less compared to the previous. My pulmonologist confirmed that there was very slight improvement but my spleen has increased in size by 2 CM. He is thinking Lymphoma or Sarcoidosis at this point but spleen leans more towards lymphoma. I had a PET-CT done a few days ago that showed some uptake supraclavicular area although that area isn't enlarged. enlarged mediastinal and hilar lymph nodes with the hottest uptake at 15.3 in the mediastinal. Retroperitoneal lymph nodes with uptake measurement of 12.2. Spleen enlargement was again noted and findings were concerning for a process such as Lymphoma.
After a follow up with my pulmonologist, they now want to do a biopsy with bronchoscopy-EBUS or mediastinalscopy. I chose bronch first, then the other if the broncho fails. My Dr. is still leaning more towards sarcoid and said that sarcoid can make a PET light up. I'm just not convinced since there was some really hot areas but I don't know. Anyway, very anxious about this. I just want some opinions about this. As of now I have no symptoms related to lungs. Never had shortness of breath. The symptoms that I did have have went away after antibiotics. I understand the most if not any of you are doctors and I am not looking to get a diagnosis on the internet. I'm just curious if any of you have had an enlarged spleen at diagnosis and had uptake on your petscans. Thank you in advance for the help.
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