Concerns Regarding Lung Nodules and Possible Tuberculosis
Greetings! I am a 47-year-old female who does not take any medications and does not smoke. For the past year, I have experienced intermittent coughing, which I initially attributed to lingering effects from COVID-19. Occasionally, I could hear phlegm in my lungs, but I didn't encounter any other symptoms at that time. Recently, I noticed mild fever, with evening temperatures fluctuating between 37.0 and 37.5 degrees Celsius. This prompted me to undergo a chest x-ray. Overall, I feel well and haven't experienced any breathlessness. The x-ray revealed multiple shadows measuring up to 15mm, leading to the necessity of a CT scan, the results of which I will summarize (translated from another language): - The rib cage appears normal in shape. - No visible abnormalities are found in the soft tissues of the rib cage. - The tracheobronchial tree is normally developed, with the trachea and bronchi showing no obstructive formations. The walls of the bronchial tubes are unevenly thickened on the left side. - Lung roots and mediastinal structures are clearly defined. **Lung findings:** - On the right lung, no infiltrative changes or masses are evident. - In the left lung, particularly in segments S1+2, S4, S5 of the upper lobe and S6, S9, S10 of the lower lobe, there are numerous scattered polymorphic foci, varying from minimally detectable sizes to 13mm. Notably, segments S5 and S10 show areas of consolidation in the lung tissue, the largest measuring approximately 33 x 16mm in segment S10. - No fluid accumulation is detected in the pleural spaces. - The mediastinum remains in its normal position and is not dilated, showing no additional formations. - Intrathoracic lymph nodes appear normal in size and density. - The heart is situated normally, with no enlargement. - There is no fluid observable in the pericardial cavity. - The aorta maintains a normal diameter. - The pulmonary artery trunk is also of standard size. - No bony lesions were found in the ribs, sternum, or thoracic vertebrae. The Diaskin test returned positive results. The following are the results of my complete blood count (CBC): - Red Blood Cells: 4.65 (normal range 3.92-5.08) - Hemoglobin: 125 (normal range 119-146) - Hematocrit: 38.6% (normal range 36.6-44.0) - Mean Corpuscular Volume: 83.0 fL (normal range 82.9-98.0) - Mean Corpuscular Hemoglobin Concentration: 32.4 g/dL (normal range 31.8-34.7) - Mean Corpuscular Hemoglobin: 26.8 pg (normal range 27.0-32.3) - Red Cell Distribution Width (SD): 45.9 fL (normal range 38.2-49.2) - Red Cell Distribution Width (CV): 14.4% (normal range 12.1-14.3) - Platelets: 299 (normal range 173-390) - Mean Platelet Volume: 9.9 fL (normal range 9.1-11.9) - Plateletcrit: 0.30% (normal range 0.18-0.39) - Platelet Distribution Width: 11.7% (normal range 9.9-15.4) - White Blood Cells: 6.87 (normal range 4.37-9.68) - Neutrophils: 5.21 (normal range 2.00-7.15) - Neutrophils %: 75.8% (normal range 42.5-73.2) - Eosinophils: 0.23 (normal range 0.03-0.27) - Eosinophils %: 3.3% (normal range 0.0-3.0) - Basophils: 0.03 (normal range 0.01-0.05) - Basophils %: 0.5% (normal range 0.0-0.7) - Monocytes: 0.45 (normal range 0.29-0.71) - Monocytes %: 6.5% (normal range 4.3-11.0) - Lymphocytes: 0.95 (normal range 1.16-3.18) - Lymphocytes %: 13.9% (normal range 18.2-47.4) I find it hard to believe that I might have tuberculosis, as I have not been in close contact with anyone who is ill. Since 2021, I have primarily been working from home, venturing out only for groceries. I live alone and see my family members infrequently, perhaps twice a month. I wonder if my previous job in customer service before 2021 could have exposed me to an infection that long ago? (Apologies for my English)
Answers (1)
8/14/2025, 12:41:32 PM
OpenHealth AI
Thank you for sharing your situation. It’s understandable to feel concerned about your health, especially with recent findings. You have multiple lung nodules noted on your CT scan and a positive Diaskin test, which raises the possibility of tuberculosis (TB) or other lung issues. It's good that you are gathering information and seeking clarity.
Summary of Key Points:
- Lung Nodules: Presence of multiple nodules and areas of consolidation.
- Positive Diaskin Test: Indicates exposure to TB, but does not confirm active infection.
- Symptoms: Intermittent cough, mild fever, occasional phlegm, no breathlessness.
Explanation:
The findings from your CT scan, particularly the various nodules and consolidation, require careful consideration. The positive Diaskin test suggests prior exposure to TB or a latent TB infection. However, many people may test positive without having active disease, especially if they haven't shown symptoms indicative of TB like weight loss or severe night sweats.
As you also mentioned limited contact with others in recent years, it seems less likely that you contracted TB recently, though exposure from previous work in customer service is a possibility.
Next Steps:
-
Monitor Symptoms:
- Keep track of your cough and any additional symptoms, such as weight changes, sweating at night, or increased fatigue.
-
Hydration and Throat Care:
- Drink plenty of fluids to soothe your throat and help clear mucus. Warm teas with honey may be calming.
-
Follow-Up Testing:
- Based on your recent results, follow up with your healthcare provider about further tests. This may include a sputum test or a bronchoscopy to evaluate the lung nodules more closely for TB or other potential issues.
-
Mental Well-Being:
- It’s normal to feel anxious about health matters. Consider talking to someone supportive about your feelings or reach out to a counselor if you need additional support.
-
Lifestyle and Health Maintenance:
- Continue eating a balanced diet, engage in light exercise as tolerated, and ensure you’re practicing good respiratory hygiene (like washing hands) to keep yourself healthy.
If you develop worsening symptoms like increased fever, difficulty breathing, or significant changes in your cough, consider seeking immediate medical attention.
Please remember to follow up with your healthcare provider to discuss your test results and the best approach to manage your health moving forward. Let me know if you have further questions or need more information.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.