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This question was answered on Sat 18, Apr 2009 04:16am by Dr. Monica, MD

Lymphoma symptoms, but MRI and bloods clear, what to do next?


    
Asked by photogirl (Female; 34; Gall Bladder removed at 18, Pre-eclampsia 3 yrs ago with birth of child.; Relevant drugs:Ibuprofen for pain ) on Thu 16, Apr 2009 05:22pm
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I was suspected of having lymphoma with my symptoms I have experienced over a 4 month period. I had an MRI of the neck and head which showed nothing significant. An Ent checked my throat with a tube and did not find anything suspicious there. As the symptoms have only intensified over time, would it be better for me to have a cat scan or possibly PET cat scan? Any advice appreciated. Symptoms: Lump in Neck on one side (ENT said it may be an enlarged muscle) Slight lymph swelling along neck and swelling of glands, including parotid and submandular mostly on one side, but now both. Chest pain, short of breath feeling. Swollen Tonsil on one side. Sore Throat. Puss type stuff possibly from parotid. Numbness of face and mouth. Choking throat feeling. Upper Abdominal pain. Pain in pelvic/groin area. Hot flashes. Night Sweats. Slight Fever. Itchy Skin.
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Answer by Dr. Monica, MD  on Sat 18, Apr 2009 04:16am:

Hi, Your symptoms do not conform to any particular diagnosis. You said that your MRI of the face and neck is normal. Any enlarged lymph nodes and salivary gland should have been evident on the MRI scan. You said that you have an enlargement of one of your tonsils. Did your ENT doctor notice this and has he given his opinion regarding the tonsillar enlargement or is this something that you have subjectively felt on your own? Also any enlargement of the salivary glands and a pus discharge should have been evident on clinical examination and on the MRI scan. MRI is a good imaging modality for the face and neck and is superior to a CT scan for soft tissues. Therefore at this point a CT scan is unlikely to provide any additional information. Also, from your description, there seems to be no indication for a PET CT scan at present. I would suggest that you consult your doctor again and discuss the possible causes of your symptoms. If your lymph nodes/salivary glands/tonsils are truly enlarged then a biopsy can be taken from the enlarged gland/s to ascertain the diagnosis. Other possible causes of your symptoms could be infection, hormonal imbalance, allergic reaction, stress etc. so it would be prudent to consult your doctor to rule them out. All the best and God bless!

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Comment by Dr. Monica, MD on Sun 19, Apr 2009 01:53pm: Hi, It would be helpful if you could let us know how long has it been since you've had the MRI and the clinical examination done. In case a few months have elapsed a repeat examination &/or imaging may provide additional information if your disease has progressed in the interim. If any suspicious swelling/s are found, a biopsy or FNAC is recommended. You might want to consult an internist or an oncologist for a second opinion. All the best!

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