Concerns Regarding Enlarged Occipital Lymph Node and Thyroid Nodule
Greetings! I am a 26-year-old male weighing 199 lbs and standing at 5’8”. I served in the Gulf War. Over the last four years, I have experienced fluctuating blood counts, particularly with my white blood cells, while both my hemoglobin and red blood cells have remained stable within normal limits. Additionally, I have been diagnosed with splenomegaly, which measures up to 17.3 cm. I undergo regular scans to keep an eye on my spleen and lymph nodes. A couple of weeks ago, I underwent a CT scan of my neck because I discovered two bumps on either side. The findings from the scan included: - A notable enlarged left occipital chain lymph node measuring 1.1 x 1.0 cm (as seen in an axial image). - Additional non-specific bilateral cervical chain lymph nodes were observed, but there is no evidence of cervical adenopathy according to the CT size criteria. - A scalp examination is recommended, along with considering a focused ultrasound to assess internal characteristics and the potential for ultrasound-guided tissue sampling. Moreover, I have a nodular area on the right posterior thyroid lobe measuring 8 mm. This could possibly be an exophytic nodule or related to the parathyroid. Could someone simplify this for me? A scalp exam with dermatology sounds odd to me. Why is a thyroid nodule only being detected now when my full-body scan in May indicated no abnormalities? Also, there was no lymphadenopathy noted during that scan. At that time, it was only mentioned that I had splenomegaly and borderline mesenteric lymph nodes measuring up to 1.0 cm along the long axis, which were described as common incidental findings due to their location. I am extremely frustrated with the endless cycle of scans and consultations. My trust in the VA healthcare system is dwindling. Should I advocate for further testing?
Answers (1)
8/27/2025, 12:12:48 PM
OpenHealth AI
Thank you for sharing your concerns and experiences. It’s understandable to feel frustrated with ongoing scans and consultations, especially when dealing with health complexities. Let's break down your situation and focus on key points.
Main Points
- Enlarged Occipital Lymph Node: It's not uncommon to find lymph nodes that fluctuate in size and sensitivity, especially following infections or other immune responses.
- Thyroid Nodule: A nodule on the thyroid can develop over time and may not have been evident in earlier scans due to several factors, including changes in size.
- Your Frustration: It’s valid to feel overwhelmed, but having comprehensive evaluations helps ensure that nothing significant is missed.
Explanation
- Lymph Node Enlargement: Lymph nodes can swell for various reasons, including infections, inflammation, or even benign conditions. The fact that a specific lymph node is enlarged is something worth monitoring, but the size you've mentioned (1.1 x 1.0 cm) is generally not alarming by itself, especially if there are no other concerning symptoms.
- Thyroid Nodules: An 8 mm nodule is relatively small and often not a cause for immediate concern, but it requires monitoring. The nodules can develop over time, and changes in size or characteristics can prompt further testing.
- Sc scans and Protocols: The recommendation for a scalp examination and ultrasound of the thyroid is part of a thorough approach to understand the nature of both the lymph nodes and the nodule. It's not uncommon for a nodule to be detected at different times depending on factors such as image quality or size changes.
Next Steps
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Continue Monitoring: Schedule and attend the recommended ultrasound and scalp exam. These tests will provide detailed information that is crucial for understanding the next course of action.
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Document Symptoms: Keep a diary of any new symptoms (e.g., changes in lymph node size, swelling, changes in thyroid function, fatigue, etc.) to share with your healthcare provider at future appointments.
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Advocate for Clarity: If you're feeling frustrated, consider expressing your concerns directly during your next appointment. Discuss the possibility of consolidating tests or consultations to reduce the feeling of constant evaluations.
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Seek a Second Opinion: If you're feeling unresolved or uncertain about the care you're receiving, don’t hesitate to seek a second opinion from another specialist. This can provide reassurance and clarity moving forward.
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Stay Informed: Educate yourself on both thyroid nodules and lymphadenopathy. Understanding the basics can empower you to make informed decisions and ask relevant questions during consultations.
Your health is the priority, and effective communication with your providers can help enhance your experience. Remember, it’s okay to seek clarity and advocate for your needs. Let me know if you need additional information or support.
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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.