Seeking Reassurance on the Loss of Fatty Hilum in Lymph Nodes
I hope someone can provide me with some reassurance regarding the absence of a fatty hilum in lymph nodes. My ultrasound results were quite vague, merely noting the sizes of the lymph nodes while the medical professionals indicated that the fatty hilum wasn’t observed. Recently, I shared my concerns here. I’ve been facing fluctuating symptoms and am overwhelmed with anxiety. After losing my emotional support animal to Large Cell Lymphoma linked to a neck tumor last year, I’m understandably a bit shaken. ### Personal Information: - Age: 28 - Gender: Male (assigned female at birth) - Medication: On Zoloft daily for approximately eight years to manage depression. - Family Health: No significant history of related conditions. ### Health Summary: - Blood tests indicate normal results, with a slight elevation in hematocrit levels. ### Current Symptoms: - Swollen lymph nodes behind the sternocleidomastoid (SCL) muscle in the neck, persisting for about a month and a half, with a sense of growth. - A newly experienced stuffy sensation in the left ear (the same side as the swollen lymph nodes). - A peculiar thickness felt in my neck that is difficult to articulate; I can physically sense the lymph nodes along with a feeling of pressure. - Recently noticed mild chest discomfort, which I suspect could be anxiety-related. - Night sweats that have been ongoing for roughly two years. - A slight weight loss of about five pounds over the past month, which I initially attributed to stopping testosterone for gender affirmation two months ago, affecting my appetite. - Enduring fatigue since childhood. Upon reviewing my ultrasound results, I found it alarmingly vague. There were no specifics regarding echogenicity, margins, vascularity, hilum, etc. The report only detailed their sizes. When I inquired with my medical team about whether the hilum was observed, they informed me that the radiologist had omitted it, implying it wasn’t visible. Isn’t that significant information? Isn’t the presence or absence of a fatty hilum an important factor when considering malignancy? ### Ultrasound Findings: - **Technique:** Real-time ultrasound imaging of the neck’s soft tissues with documentation. - **Comparison:** None provided. - **Findings:** A number of lymph nodes were identified in the left neck, with the largest measuring: - 1) 1.7 x 1.3 x 0.3 cm (zone 5) - 2) 1.3 x 0.7 x 0.5 cm (zone 5) - 3) 2.4 x 0.8 x 0.7 cm (zone 2) - **Impression:** Several lymph nodes detected on the left side of the neck's soft tissues warrant short-term follow-up or additional evaluation as clinically indicated. ### Additional Context: I have been consulting with Physician Assistants (PAs), while a radiologist conducted the ultrasound report. I currently do not have a primary care physician (PCP) due to the lengthy wait time to establish care — my appointment is scheduled for next month. Unfortunately, I cannot access an earlier appointment, but I plan to request a referral to an ENT specialist. ### Final Thoughts: I genuinely need to understand if the absence of the fatty hilum in multiple lymph nodes can indeed be normal. I keep encountering alarming information online suggesting an 80% likelihood of cancer, which intensifies my panic. It seems my provider didn’t find it necessary to mention this detail. Could this possibly be related to an ear infection? I lack significant pain, so is it reasonable for these symptoms to last this long without additional indicators?
Answers (1)
6/16/2025, 8:50:51 PM
OpenHealth AI
I understand that you're feeling anxious about the findings from your ultrasound, especially considering your previous experiences and the symptoms you are currently facing. Let’s break down the information and help you gain clarity and reassurance about your situation.
Key Points:
- Absence of Fatty Hilum: The fatty hilum is a normal structure found in lymph nodes that helps distinguish between benign (non-cancerous) and malignant (cancerous) conditions. However, its absence in itself does not automatically mean you have cancer.
- Symptoms and Lymph Node Characteristics: Swollen lymph nodes can result from various causes, including infections, inflammation, and less commonly, malignancies. The clinical context of symptoms is crucial.
- Next Steps for Reassurance and Care: Focus on monitoring your symptoms and addressing anxiety while you prepare for your upcoming appointments.
Explanation:
The fatty hilum may not always be visible in ultrasound imaging, and its absence can occur in both benign infections (like an ear infection or a cold) and malignancies. The size and characteristics of the lymph nodes, along with your specific symptoms, are what doctors consider when assessing any potential issues.
Your symptoms, including the sensation in your neck, ear stuffiness, and night sweats, could suggest several conditions. While it’s important to be vigilant, many benign causes could explain these symptoms. The absence of significant pain and the slight weight loss may also relate to anxiety or medication changes, especially with stopping testosterone recently.
Prioritized Next Steps:
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Symptom Monitoring: Keep a daily log of your symptoms, including any changes, intensity levels, and new occurrences. This information can help your medical team understand your situation better.
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Follow-Up Care: Since you have an upcoming appointment with a primary care physician (PCP), prepare any questions or concerns to discuss, especially regarding the ultrasound results. Requesting a referral to an ENT specialist is also a good step, particularly given your ear symptoms.
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Anxiety Management: Continue taking your Zoloft as prescribed and consider other anxiety management techniques, such as mindfulness exercises, deep breathing, or physical activity, which can help reduce anxiety.
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Healthy Lifestyle: Maintain a balanced diet and stay hydrated to support your overall health. Gentle exercise (as tolerated) and adequate rest can also be beneficial.
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Emergency Signs: If you experience significant changes like new chest pain, rapid weight loss, severe fatigue, or other alarming symptoms, seek medical help sooner.
Reassurance:
It's completely understandable to feel anxious given your history and current symptoms. Many factors can lead to swollen lymph nodes, and most are not serious. Continue to engage with your healthcare providers, as they can offer further reassurance and a clearer picture once they have all information available. Remember that anxiety can amplify physical sensations; taking steps to manage it can help you feel better overall.
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