I'm a 35yr old female with no significant prior health issues. Approximately 8 weeks ago, I went to my primary care NP for what I thought might be an enlarged lymph node. My NP started me on Augmentin x 2 wks and also ordered an ultrasound of the affected area. Ultrasound showed 2 supraclavicular lymph nodes which were "prominent but not enlarged by size criteria" - 17x9x7 mm and 5x5x7 mm (normal vascularity & fatty hilum). When the palpable abnormality did not resolve with antibiotics, I was referred to an ENT. The ENT ordered chest rads & a CBC - both were normal. After more time/monitoring, the ENT did not want to biopsy and felt there was not a problemand that the supraclavicular lymph nodes were not a concern. Most recently, I was referred to a general surgeon who ordered a neck/chest CT. CT showed no supraclavicular lymphadenopathy, but a 1.1x2.6 cm soft tissue mass anterior to ascending aorta - ddx: thymic vs lymphoid neoplasia. Radiologist recommends CT. Surgeon feels it is 'probably nothing' and that I'm overreacting to nothing, but has referred me to a thoracic surgeon to discuss biopsy.
Questions...
1. The supraclavicular mass feels the same or possibly larger than it was at the time of ultrasound. Is CT less sensitive for detecting enlarged lymph nodes, or could the radiologist be using a different threshhold for reporting that the radiologist who read the CT? Or does the lack of enlarged supraclavicular LNs on CT mean that they've gone down?
2. It seems to me that an anterior mediastinal mass is unlikely to be "probably nothing." The surgeon actually first recommended waiting 6 mos and then repeating CT but said he could refer me to a thoracic surgeon if I'd prefer. Is it likely that someone my age would still have that degree of residual thymic tissue, or would biopsy be recommended?
3. Is the thoracic surgeon consult the best option at this time, or should I try to see an oncologist or some other specialist?
Thanks in advance for yo
Reply # - June 30, 2014, 08:36 PM
Reply To: mediastinal mass +/- supraclavicular lymphadenopathy
Our thoracic surgeons typically field these questions of obtaining the diagnosis for a mediastinal mass, so I think it makes good sense to follow that referral and see about the recommendations around getting tissue after that referral. Until you have a diagnosis, I think it would be premature to seek an opinion from an oncologist -- in fact, many don't schedule patients who don't have an established tissue diagnosis of a cancer.
Beyond that, we really can't get too deep into speculating what might be going on, interpreting scans of people who aren't shown to have cancer. Our site and organization are really focused on people who have an established cancer (and at this time we are far more focused on a limited collection of cancers than a broad range), and getting deep into discussions of the "what if" scenarios of people who don't have a diagnosis is both outside of our specialization, as cancer care professionals, and is also just infeasible when we're talking about interpreting the results of scans we haven't seen from patients we aren't caring for.
Good luck.
-Dr. West