Seeking Insights on Anterior Mediastinal Mass
Greetings, everyone! This is my inaugural post on Reddit, so please bear with me as I navigate through my thoughts. I’m a 34-year-old female and recently discovered an incidental finding of a mass measuring 3.9 x 1.5 x 1.9 cm during a CT scan that was performed due to tapering in my jugular vein. For the past year, I've experienced symptoms such as shortness of breath and localized chest discomfort. Initially, my medical team and I attributed these issues to ankylosing spondylitis (AS), which I have, assuming it was affecting my ribs and sternum. However, this suspicion was never substantiated by imaging; it was primarily a theory on my part. I have also been grappling with severe fatigue, intermittent fevers, and night sweats, which I believed were linked to my existing health complications. I now question if this mass might have been the underlying cause all along. Here are some pertinent aspects of my medical history: - I have a long-standing issue with reactive lymph nodes, with two currently being monitored via ultrasound every few months. They appear reactive according to the ultrasound results. - There is a familial tendency towards hereditary hypertension that has been challenging to manage. Presently, I'm on a combination of amlodipine and lisinopril and have previously taken carvedilol. - I'm on atorvastatin to address hyperlipidemia. I maintain an active lifestyle, have a healthy weight, and follow a clean diet, adhering to a vegetarian lifestyle for nearly 28 years. - I also have ankylosing spondylitis, for which I’m undergoing treatment with biologics. - My family background includes extensive occurrences of cancer and heart-related conditions. My father passed away from a heart attack at age 40, and both his brothers and father suffered heart attacks before turning 50, though they survived. My mother’s side has a significant cancer history, with three of her sisters surviving different types. Switching back to the mass, it presents with low density on imaging. It was initially noted on a 2022 CT scan when I was evaluated for chronic bronchitis and pneumonia, but regrettably, this finding was not communicated to me. The ENT who ordered the scans relayed the information to an interventional radiologist. After reviewing my imaging history, the radiologist informed me of the previous findings. He mentioned that the mass hadn't increased in size, which is reassuring in regard to malignancy risk, but suggested a follow-up MRI with contrast, as my arm positioning differed between the two scans. I just completed that MRI today. Upon reviewing my medical chart ahead of a forthcoming appointment, I came across an addendum pertaining to this year’s CT that includes: - "A lobulated low-density lesion in the anterior mediastinum measuring 3.9 x 1.0 x 1.9 cm has been identified, consistent with a similar lesion from 2022, which measured 3.3 x 2.0 x 1.5 cm. The size has not shown significant change, though it’s crucial to note the arm positioning discrepancy between the studies. The stability observed tends to suggest a benign nature." To further clarify, the original 2025 CT mentioned a low-density lobular lesion in the anterior mediastinum measuring 3.5 x 1.0 x 1.9 cm. It seems there are variances in size reported for the mass over time, and I am concerned because it appears to have changed not just in size but potentially in shape, especially given my symptoms and its location. Additionally, recent lab tests indicated I have low potassium and iron levels, alongside mildly elevated neutrophils. I insisted on being referred to a thoracic surgeon, and my doctor facilitated that without hesitation. I'll be seeing him soon. My primary questions are: - In light of my symptoms, the growth of the mass, and my family history, would it be wise to consider a biopsy? - Based on its size, location, and my symptoms, would surgical removal be advisable? If so, what implications should I anticipate? - Can anyone explain the differences in reported size across the radiology reports? Might the MRI reveal a different measurement compared to the CT? - Finally, how serious is this finding? I apologize for the lengthy post; I feel quite overwhelmed and am searching for some clarity on this matter. I truly appreciate any thoughts or guidance you can provide. I'm also happy to answer any additional questions you might have.
Answers (1)
8/20/2025, 3:01:45 AM
OpenHealth AI
Thank you for sharing your situation; it’s understandable to feel overwhelmed by these findings, especially with your existing health conditions and family history. Let’s break this down into the main points and provide some insights and next steps for you.
Main Points:
- You have an anterior mediastinal mass that has been stable in size over time, which may suggest a benign nature, but it's important to investigate it further due to your symptoms.
- Considering your family history of malignancies and your ongoing symptoms, further evaluation (including possible biopsy) is reasonable.
- Differences in size measurements between CT and MRI can occur due to various factors, including positioning and imaging technique.
Explanation:
-
Mass Characteristics: The fact that the mass has remained stable in size is reassuring; however, your symptoms (shortness of breath, chest discomfort, fatigue, intermittent fevers, and night sweats) warrant careful evaluation. A mass in the anterior mediastinum can be related to various conditions, including benign processes (like thymoma or teratoma) or, less commonly, malignancies.
-
Family History and Symptoms: Given your family history of cancer and heart disease, along with your concerning symptoms, it is sensible to consider a biopsy. A biopsy can provide a definitive diagnosis and guide further management.
-
Variability in Measurements: Variations in reported sizes across imaging studies may result from different positioning, breathing techniques during the scan, or differences in image interpretation by radiologists. It is common for small discrepancies to occur, and the MRI may help provide additional clarity concerning the mass’s characteristics.
Next Steps:
-
Discuss Biopsy with Your Thoracic Surgeon: Bring up the possibility of a biopsy during your appointment. Explain your symptoms and family history. A biopsy can yield valuable diagnostic information to clarify the nature of the mass.
-
Follow-Up on MRI Results: While you wait for the thoracic surgeon appointment, ensure you understand the findings of the recent MRI. Ask for clarification on how this imaging might change or confirm the understanding of the mass's characteristics.
-
Prepare for Discussion on Surgical Options: If a biopsy indicates that surgical removal is an option, your surgeon will discuss the potential benefits and risks with you. Surgical interventions can vary, but understanding what to expect will help you feel more prepared.
-
Monitor Symptoms: Keep a log of your symptoms, noting when they occur and their severity. This information can be invaluable in discussions with your healthcare team and during your surgical consultation.
Support:
It’s natural to feel anxious in situations like this. Surround yourself with supportive friends or family who can help you through this process. Remember, gathering thorough information and asking questions will help you feel more in control as you navigate your care.
Feel free to reach out if you have more questions or need emotional support during this time. You are not alone in this.
Related Questions
Seeking Guidance for Ongoing Health Struggles
I genuinely need your assistance and would greatly appreciate any advice or insights you can offer. Over the past year, I've experienced tremendous pain, and despite numerous consultations, my doctors seem perplexed about its cause or how to manage it. To provide some context, I am a 23-year-old female, standing at 5'6" and weighing 117 pounds. My medical history includes ongoing issues with kidney stones since I was 16. Additionally, I underwent a tonsillectomy due to persistent tonsillitis at that age, along with an adenoid removal. Currently, I am grappling with two primary symptoms, the most concerning being difficulties with eating. I've shed between 55 to 60 pounds over the past two years, with 10 to 15 of those pounds lost in the last three months alone. Swallowing has become a significant challenge; it often feels as though food is lodged in my throat, requiring multiple attempts to swallow. I've also noticed that the lymph node on the right side of my neck appears slightly enlarged compared to the left, occasionally causing discomfort described as a poking sensation or tenderness. However, the main issue doesn't feel like a typical sore throat; rather, it involves my throat muscles or nerves. I experience spasms, numbness radiating from my jaw to my temple, and sharp, cramping pains akin to a Charlie horse. Interestingly, these symptoms are reminiscent of what I experienced prior to my throat surgery. After the surgery, I developed ARFID (Avoidant/Restrictive Food Intake Disorder) and faced significant health anxiety, which I managed well until around age 21 or 22. Since June 1st, I have encountered excruciating pains in my chest—left, right, middle, and in my upper back—that feel debilitating and often leave me breathless. The discomfort is persistent, accompanied by a stabbing "lightning bolt" sensation that appears unpredictably, lasts for about 5 to 10 seconds, and leaves a lingering soreness that necessitates shallow breathing to avoid aggravating it. Sleeping on my side or lying flat exacerbates the pain. A rheumatologist diagnosed me with fibromyalgia but provided no pain management or clear guidance. Now my primary care doctor, who has been addressing my concerns, is expressing skepticism regarding the fibromyalgia diagnosis. It’s crucial to mention that my calorie intake has been significantly reduced due to the discomfort associated with eating. As for the tests I have undergone: - Multiple EKGs returned normal results. - A brain MRI conducted a year and a half ago was unremarkable. - A CT scan of my lymph nodes was also within the normal range. - My ANA blood test was positive. - I tested negative for other autoimmune diseases during my last assessment. - My ferritin levels were found to be low. - An allergy test indicated no sensitivities to the items tested. - The ENT specialist dismissed my concerns, attributing my symptoms solely to fibromyalgia without taking me seriously.
Understanding Dementia and Delirium: A Personal Account
My father, an 81-year-old veteran, was diagnosed with mild cognitive impairment approximately a decade ago after a thorough evaluation by the Alzheimer’s department at our university medical center. As time progressed, about five years later, his condition worsened. He was reassessed by both a neurologist and a psychologist at a local practice, resulting in a diagnosis of frontotemporal dementia. Each of these assessments aligned perfectly with his exhibited symptoms. He has been prescribed several medications and, fortunately, his disease has advanced much more slowly than anticipated. I believe the last stage they indicated was stages 5 to 6. The medications he is currently taking include amlodipine, escitalopram, rosuvastatin, tansulosin, donepezil, memantine, trospium, vitamin B12, and a multivitamin. Recently, after undergoing evaluations at the VA, a geriatric physician informed us that my father's cognitive tests revealed he fell within the average range for all assessed areas. Additionally, they conducted a sleep study that confirmed the presence of obstructive sleep apnea (OSA). Remarkably, they stated he does not have dementia but rather is experiencing delirium due to insufficient oxygen supply to the brain. He received his CPAP device last week, but all assessments were completed prior to this treatment, during what they described as a delirious state. My mother and I were present during some of his cognitive evaluations and directly observed him struggling to draw a clock accurately, failing to recall certain words, and having difficulty connecting information, which leaves me perplexed by the conclusion that he tested in the average range. Considering his symptoms, it is hard for us to accept that his issues stem solely from sleep apnea. We truly hope this is the case, as I long for the return of the father I used to know. However, my father currently can’t recall my last name from my marriage, fails to recognize my home despite frequent visits, consistently forgets locations in my house—including where the bathroom is—cannot remember the names of family members he doesn’t see often, occasionally confuses the names of my sister-in-law and even my husband, whom he sees regularly. He struggles to recognize a family camp we owned for 15 years before selling it in 2007 and cannot remember how to navigate familiar routes, preventing him from driving. Simple tasks, like ordering from a menu, leave him indecisive, and he often makes impractical food combinations, such as mixing peanut butter with taco shells or drenching foods in syrup with cheese. The geriatric physician and physician assistant expressed frustration at our skepticism, but it is crucial to point out that my father underwent exhaustive assessments by other specialists, likely even more in-depth than the evaluations performed by the VA. The preceding diagnoses resonated with us; this recent one, however, doesn’t seem to fit. The notion that he tested within the average range for cognitive functions entirely baffles me. Is it possible that my father could genuinely improve? Can his symptoms really be attributed to sleep apnea and delirium? Has anyone encountered similar cases with these symptoms?
Navigating the Journey from Iron Deficiency to Excess: Understanding My Situation
I am currently waiting for further investigations after being referred to a specialist, and I find myself quite perplexed by the situation. As a 22-year-old female weighing 80kg and standing at 159cm, I have been diagnosed with hypermobile Ehlers-Danlos Syndrome (hEDS), fibromyalgia, dysautonomia, hypothyroidism, and fatty liver disease. I am starting to suspect that the issues with my liver might be linked to this iron imbalance. While I have other health conditions, these four have the most significant impact on my daily life. My current medication regimen includes Yaz, 50mcg of levothyroxine, 300mg of Gabapentin, a magnesium supplement, and an as-needed 8mg Ondansetron wafer for nausea. My history with iron levels has been quite tumultuous. I experienced my first menstrual period at age 9, which was excessively heavy. This prompted a screening that revealed I was iron deficient. By age 12, I began taking iron supplements, as my parents initially tried to address the deficiency through dietary changes. Just a month later, however, my iron levels were reported as 'too high', with a transferrin level that I distinctly recall being around 8. After discontinuing the supplements, my iron and transferrin levels plummeted, arguably reaching their lowest point of 7. At 14, I attempted a different formulation of iron supplements, which also led to similar complications. Consequently, I started Yaz, believing it might alleviate the heavy periods contributing to my deficiency. When I turned 19, I opted for an iron infusion due to persistent low iron levels and issues with fatigue. Now, at 22 and under a new doctor’s care, she has documented that my iron levels remain elevated and has tested me for hemochromatosis. The only positive result was for the H63D mutation, and I have been referred for additional assessments. Blood work results are available in the comments. I have several questions I hope to clarify: 1. Could this elevated iron level be the reason for my overload? My doctor pointed out that my past deficiency might complicate matters. 2. Are these elevated levels contributing to other health complications I face, such as fatty liver, decreased libido, and difficulties with maintaining my weight? I have been diligently calorie counting based on advice from medical professionals here, and I assure you I am consuming 1400 calories daily. Although I have always had a stockier build, I am finding weight management increasingly challenging.
Seeking Clarity on Ongoing Health Issues: A Call for Guidance
I'm a 27-year-old woman weighing around 120 pounds, diagnosed with gastroparesis confirmed through a gastric emptying study and further testing a couple of years later. I also have an Atrial Septal Defect (ASD). My current medications include Venlafaxine and Gabapentin. For several years, I have struggled with persistent gastrointestinal problems characterized by severe constipation needing medical intervention, alternating with bouts of diarrhea. I frequently experience constant nausea, vomiting several times weekly, as well as dizziness. My blood pressure has fallen quite low—recorded at 77/43 last month—accompanied by symptoms of orthostatic hypotension. Holter monitor tests have revealed episodes of tachycardia, and I often face abnormal sodium levels each time my blood is tested. Despite drinking an adequate amount of water, I continue to deal with dehydration, even during hospital stays where my oral intake is monitored. I also void large volumes of urine and struggle to maintain a stable weight, evidenced by a low hemoglobin A1C of 4.3, worsening fatigue, and recently, increasing joint pain. I'm at a point of frustration and despair with my ongoing symptoms. Both my physician and dietitian have recommended that I gain some weight due to muscle wasting and overall weakness, but despite their encouragement, I’m just managing to stay within a normal weight range due to my persistent lack of appetite and the pain and nausea I often experience. As a teaching academic librarian, I find it challenging to concentrate at work, struggling to process information while reading and often feeling overwhelmed by exhaustion. I'm in a position where I haven't had to stand much recently, but with the academic year starting, I’m worried about my ability to manage my responsibilities. I have experienced consistently low sodium levels, which typically provoke suggestions to increase my salt intake; however, I have been advised to take electrolyte supplements by both my primary care provider and a cardiologist I consulted a few months back, which makes me doubt that this is the core issue. I wake up almost nightly feeling starving and excessively sweaty. Being in constant pain, fatigue, and illness leaves me feeling miserable and depleted—I’m not sure how much longer I can endure this. My sick leave at work has nearly depleted because I tend to use every bit of time I gain for days when symptoms flare up or when getting out of bed feels impossible. Working in a medical library exposes me to a variety of academic literature while I conduct research for students and faculty or teach information literacy. Recently, while undertaking research for an article, I stumbled upon Addison’s disease and noted that many of the associated symptoms resonate with my own. However, I am also aware that a lot of symptoms can be quite general and ambiguous. Should I pursue this line of inquiry further with my doctor and consider testing? Just recently, I had a completely normal EGD and colonoscopy, which have ruled out any common issues typically found through these procedures. A vascular CT scan has also ruled out Superior Mesenteric Artery (SMA) syndrome and Median Arcuate Ligament Syndrome (MALS). I feel lost and uncertain about the next steps to take regarding my health concerns.
Can High Sodium and Low Potassium/Magnesium Diets Lead to Pitting Edema?
Hello! I'm contemplating whether a visit to a cardiologist is necessary. The question posed in the title is what I’m curious about, but I’d like to share additional information that might be important for understanding my situation: - I've recently put on some weight due to a happy relationship, which has involved an increased intake of processed foods. - I also consumed alcohol quite frequently over the summer, but I have completely cut it out after recognizing it was becoming problematic. - The pitting edema I've experienced is localized to just above my shins. After a long day, I frequently notice prominent sock markings, which seem worse than before. - The last time I was at my current weight, I also dealt with pitting edema. I’m uncertain if it disappeared when I lost weight in between, but I certainly felt better overall during that phase. Other symptoms I've been experiencing include: - A combination of headaches and chest discomfort that arises with adrenaline rushes linked to anxiety, which is difficult to articulate. - Occasional aches in my left arm and shoulder, not directly associated with the headaches or chest pain. This might be anxiety-related? - I do not experience breathing difficulties when lying down, and I can usually fall asleep without issues. - Shortness of breath only surfaces during exertion. There's no accompanying lightheadedness or dizziness. - My resting heart rate is around 100 beats per minute, which has noticeably increased with my weight change. Regarding my medical history: - In 2022, I visited the ER due to chest pain and vomiting. An EKG revealed right axis deviation and right atrial hypertrophy. A subsequent discussion brought up the possibility that low potassium levels in my blood might have contributed to those findings. - In 2021, a cardiologist recommended a Holter monitor to investigate potential arrhythmias, which returned normal results. - In 2018, an EKG indicated arrhythmia, though I cannot recall the specifics. Given this background, I’m eager to hear your thoughts on my dietary concerns and symptoms, and whether they warrant a cardiology consultation.