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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Bilateral Stiffening Of The Neck, Dull Ache Under Left Clavicle, Strange Feeling In Lungs. What Is Going On?

I am a married male almost 45 years w normal BMI (life-long vegetarian, no drinking or smoking) but noticed an enlarged L Supraclavicular node in Nov 2012 which has maintained its size of 1.5 cm since first detected to today s date. CBC and WBC are all within norms as of Nov. My first symptoms started w a bilateral stiffening of the neck (but more pronounced neck stiffness when turning my head to the left following ACLS certification August 30th, 2012 (I am a new RN). I originally thought performed the CPR in an awkward position but the neck stiffness persisted to mid-Nov. MD tested me for Ebstein-Barr Virus which came back positive with elevation of 749.9 (N 172.0 (N21.9), Early D IgG 17.9 (N 10.9). I was referred to an ENT , who simply looked in in my Ears, Nose and Throat stating all tissues appeared normal. He felt LSC node and stated it was 1.5 cm and I indicated it had not changed sizes since first noted, nor has it since. All current symptoms: Dull ache under left clavicle from neck to shoulder (most common). Also more recently the dullness has become bilateral with a weird feeling in the area of the tips of the lungs under both clavicles. I occassionally will have slight ichiness on neck in the same vicinity of the ache, but just very slight. I am quite exhausted most of the time. (my neck is no longer stiff but was for at least 4 months) I have no other symptoms, no cough, no noticable SOB (other than the fact that I have been sedentary for the past 4 years in school). I am a bit frustrated with the two physicians I have seen. I jus don t feel right...... and am exhausted. Any specific suggestions that they didn t think of on the diagnostic differential? I understand lymphoma is a possibility, but there is no indication that in the MDs opinons, and the ENT surgeon would not do a biopsy due to loction of node near nerve plexis.
Mon, 25 Nov 2013
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Radiologist 's  Response
hello,
thanks for using healthcare magic.
Possibility of lymphoma is highly unlikely and it should be an inflammatory lymph node as you also have history of infections.
Biopsy is NOT necessary at this stage.
You can undergo an USG to confirm an inflammatory node and then be on yearly follow up. If it increases in size then you should be worried and get a biopsy done.

Regards,

Dr. Pankaj Nagori
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Bilateral Stiffening Of The Neck, Dull Ache Under Left Clavicle, Strange Feeling In Lungs. What Is Going On?

hello, thanks for using healthcare magic. Possibility of lymphoma is highly unlikely and it should be an inflammatory lymph node as you also have history of infections. Biopsy is NOT necessary at this stage. You can undergo an USG to confirm an inflammatory node and then be on yearly follow up. If it increases in size then you should be worried and get a biopsy done. Regards, Dr. Pankaj Nagori