question-icon

I’d Like To Know What Other Diagnostic Possibilities I Have

default
Posted on Sun, 1 Sep 2019
Twitter Sun, 1 Sep 2019 Answered on
Twitter Last reviewed on
Question : I’d like to know what other diagnostic possibilities I have for some recent issues/tests. I went to ER in XXXXXXX for chest pain and pain in my back on right side when I breathed. I had an X-ray that just suggested Emphysema, but because I had just driven for 9 hours straight the dr suspected a PE. I had a CT scan and also a D-dimer which didn’t suggest PE. There was a 2 cm mass on my right upper lung and perhaps inflammation in my lymph nodes. Diagnosed with pneumonia and went back on the road for the remaining 2 hours of my trip. Went to PCP when I got home. She did another CT about a month later. Node was a lil bigger though not significantly so. I was sent to a pulmonologist 2 days later, and a PET that week. PET indicated lung cancer with lymph node involvement. I had a biopsy that was negative. They didn’t biopsy the node bc it was in a dangerous spot. 2 weeks later biopsy of node and several lymph nodes at another facility. All negative. Both bronchoscope.
So now, we are scrounging for other possibilities. TB negative. HIV negative. 4 different funguses negative. And as for the pneumonia diagnosis, I only had the pain. No fever, recent illness, or coughing. CBC normal. ESR was normal and then was abnormal after 1st biopsy. ESR normal. One stain of biopsy showed nucleated red blood cells which so far seems to be the only abnormal thing.
Symptoms-extreme fatigue, appx 8 months. PCP said it was depression or fibromyalgia, still ongoing; drenching night sweats. Saw gynecologist. I’m not in menopausal age and all of my hormone levels came back just fine; shortness of breath, diagnosed with Emphysema. Long time smoker. Intermittent chest pain. Last 3 EKGs suggest prior heart attack. Had EKG last year and year before that was normal.
So what else could be going on? Any other possibilities we’ve not yet considered and/or tested for? False positive PET-CT, fatigue, night sweats, chest pain.
doctor
Answered by Dr. Bhagyesh V. Patel (7 hours later)
Brief Answer:
possibility of sarcoidosis or other auto immune mediated condition.

Detailed Answer:
Hello and welcome to Ask A Doctor services.
I have read your query and here is my advise.

* The assembly of symptoms with excess fatigue, night sweats, chest pain
with this duration and negative evaluations suggestive of other
possibilities, I suspect possible auto immune disorder underlying which
may had flared up and presented as pneumonia at initial appearance
clinically ( though its process at subclinical level is hidden behind curtain )

* Sarcoidosis is one of the diagnosis of exclusion and should be considered,
important evaluation is serum ACE ( angiotensin converting enzyme ) level
and broncho alveolar lavage fluid analysis.

However, if you can provide scanned copies of all your available reports as attachment in follow up session, it would be of immense help to go through thorough details needed.

Awaiting for your response.
Regards.

Dr Bhagyesh ( MS consultant surgeon )
Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Bhagyesh V. Patel

General Surgeon

Practicing since :1999

Answered : 20405 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
I’d Like To Know What Other Diagnostic Possibilities I Have

Brief Answer: possibility of sarcoidosis or other auto immune mediated condition. Detailed Answer: Hello and welcome to Ask A Doctor services. I have read your query and here is my advise. * The assembly of symptoms with excess fatigue, night sweats, chest pain with this duration and negative evaluations suggestive of other possibilities, I suspect possible auto immune disorder underlying which may had flared up and presented as pneumonia at initial appearance clinically ( though its process at subclinical level is hidden behind curtain ) * Sarcoidosis is one of the diagnosis of exclusion and should be considered, important evaluation is serum ACE ( angiotensin converting enzyme ) level and broncho alveolar lavage fluid analysis. However, if you can provide scanned copies of all your available reports as attachment in follow up session, it would be of immense help to go through thorough details needed. Awaiting for your response. Regards. Dr Bhagyesh ( MS consultant surgeon )