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Dec '07

Diagnose Me!

I am posting an image and three movies.

The image represents a chest x-ray that was performed on May 2, 2006.  The collection of movies are of a CT scan that was performed in early December.

I am hoping that a few qualified (and curious) individuals will take the time to review the scans and will be gracious enough to give their two cents regarding a diagnosis. Optimally, by making these records public I will attract a few quality outside diagnoses and hopefully those diagnoses will be in line with what my doctor has already stated.  If there are differing opinions on the scans, at least I can bring these points up with my next doctor’s appointment to have them addressed.

Before I get yelled at by the rest of the world stating "why the hell are you relying on stranger for your diagnosis!" let me reiterate that I have already been to one specialist and am getting a second opinion on Jan 2nd just to be safe.

I am intentionally keeping the details behind my diagnosis vague. I want all assessments done solely by the data presented.

I have a pretty good BS detector, so please don’t tell me that I have Leprosy. :-)

So if you’re a doctor or pre-med student, or if you’re a fan of “House”, post your best diagnosis.  Once you have your diagnosis, go ahead and read the comments. There I will give further information on my circumstances.

– Jim

Chest xray: 

Click to englarge


CT (AC) : Chest 5′s CHK 2ND

Hi-res images of this scan be found here along with a hi-res QuickTime version of this movie.


CT (AC) : Soft Tissue

Hi-res images of this scan be found here along with a hi-res QuickTime version of this movie.


CT : Chest 5′S CHK 2ND

Hi-res images of this scan be found here along with a hi-res QuickTime version of this movie.


20 comments to “Diagnose Me!”

  1. Kit Brennan Says:

    Your chest x-ray looks good, apart from the heart monitor leads I can’t see any obvious abnormalities, and I am no good at looking at CT scans.

    Do you have any symptoms?

  2. Dr. Smith Says:

    So sorry, you have AIDS.

  3. Dr. House Says:

    It’s not lupus.

  4. Dr. Cameron Says:

    But it is, see the enlarged lymph nodes?

  5. Dr. House Says:


  6. Jim Says:

    Kit, before the CT came about, in early October I came down with flu-like symptoms (running 103-105 temp, aching body). Constantly coughing up mucus. Sleeping for 20-22 hours a day.

  7. Drop Table Says:

    Its definitely cooties. Don’t worry, they have a shot for it.

  8. Joprawn Says:

    Unfortunately, radiology is a science, not an art. To make a proper diagnosis, we need to have clinical information to correlate the radiologic information. Age and race and smoking history would be helpful. There appears to be a solitary, irregular, nonspiculated lesion with well-defined borders. It could be a malignancy, but it is quite well defined, and the nonspiculated nature is reassuring, although if you were a 70 year old pack a day smoker, I’d be more worried. Could be infectious, inflammatory, or just an anatomic variant like a hamartoma. Have those October symptoms been with you 24-hrs a day, or did they come and go. If so, how often. Have they improved, worsened, or stayed the same?

  9. Arty Says:

    I haven’t read your story. So whatever I say in this is false.. But on first glance…
    The outline of your lung looks sharp and defined, with a good size…there is a possibility of a mass on the x-ray, (especially with the presence of more defined lymph nodes, and the fever). Like Joprawn says, a good clinical history is necessary.
    There is also a definite deviation of your bronchus to the right near the carina, possibly from an enlarged aorta at the arch. This is normal for people after a certain age though.
    You say you were coughing up mucus. Can you describe the colour and consistency?

  10. Chad T Says:

    Thank you everyone for looking at this. Jim is a great friend of mine and I hope it turns out to be just cooties

  11. Jim Says:

    I am a 29 yr old white male, never have smoked, I work out 3 – 5 times a week with both cardio and weight-training. I am 6 foot, 260 lbs.

    Joprawn and Arty, you guys are right on track with what the pulmonologist has told me. I was diagnosed with having a nodule on my lung (and this has me quite worried).

    The bronchitis symptoms were heavy for about two weeks, and then after taking anti-biotics, slowly tapered off. After the first CT scan, the pulmonologist put me on Avelox for a week, and then a week later, took a second CT scan (the scan above). The symptoms went away but the pulmonologist said that the mass did not shrink (thus ruling out it was an infection).

    Tell me this: can you see the nodule on the xray posted above? The xray was taken in 2006 and the CT scan late 2007. So if the nodule doesn’t exist on the 2006 xray but exists in the CT scan I can only conclude that it grew within that time period.

    With my upcoming appointment with a second pulmonologist, here are the issues that I want to address :

    1) Is it possible to do a biopsy without “opening me up”? How long would recovery be?

    2) What’s the probability of the nodule being benign vs. malignant?

    3) If the nodule did not exist in the 2006 xray, I want it biopsied. If it did, I will let it be.

  12. Chop_Chop Says:

    What about occupational or domestic exposure to toxins?

    They just take the biopsy with a big needle. Its no big deal.

    It could be any number of things. From what I can see in these images its only one and not a cluster. correct?
    DO GET THAT BIOPSY no matter what your current doctor says. A lot of doctors can be dismissive.You could be precancerous and it has to grow at least 3mm before even being seen on an xray. so it could of been there and just not been able to be picked up.

    It could be from an infection of a viral type or fungal.

    I hope its just a mucus impaction from a bad bronci infection.

    good luck!

  13. Chop_Chop Says:

    p.s. at your age the cancer risk is 3%. SO the odds are in your favor on that one.


  14. Chop_Chop Says:

    me again! I was trying to see if i could make it out in the picture but i couldnt really. Did they say anything about fat being in the nodule?

  15. Jim Says:

    The pulmonologist that I saw stated that generally speaking a needle biopsy wasn’t sufficient since there’s a possibility that the points at which the cells are extracted are benign, there could still be points in the growth that aren’t sampled that are cancerous.

    His recommendation was that if I was going to have it biopsied, to have the whole thing extracted. Which, along with the standard surgery risks also comes the risk of a punctured lung, etc.

    I am hoping that he is wrong about the effectiveness of the needle biopsy. I’m interested in hearing what this second pulmonologist has to say.


    P.S. Thanks for the cancer rate. :-)

  16. draeath Says:

    I would imagine the risks for a punctured lung would be minimal, in the chance that it did happen (i could only see it happening with an accident) you are already open and repaired, and they have all the people and tools they would need to deal with it quickly.

    People get shot through the lung and don’t get patched up for hours, and survive. You would have the puncture for a few minutes at most and no other damage, and have immediate attention.

  17. Arty Says:

    A needle biopsy, like the doctor said, might only get a chunk of the benign part of the mass. And if more of it is malignant, they might miss that. An open-lung biopsy does run the risks of a pneumothorax and infection, but it also has the advantage of just removing the entire mass, and you won’t have to worry about it any more. Sure it’s more dangerous, but they’re only going to do it if they feel the risk of leaving it in there is greater than going in and cutting the sucker out.
    The risks are there in surgery, but the people working on you are very good at what they do. A pneumothorax usually just means you’ll be on a ventilator for a couple more days on some morphine to keep you happy.
    If they feel it’s necessary to perform a biopsy, do it. Tumours have the possibility of being very dangerous, especially near the lymph nodes in the hilar region.

  18. Jim Says:

    Arty -

    Can an open lung biopsy be performed on an outpatient basis, or would I be sentenced to a hospital bed for a couple of days? My hope would be that it could be performed using some sort of scope with a small incision, so that it would be minimally invasive, but I may be way off on this.

  19. Arty Says:

    With an open-lung biopsy, you’ll need to be monitored for a few days because of the invasiveness and inherent risks of the procedure, as well as the need for a chest tube to be placed to remove any fluid or gas in your pleural space between your chest wall and lungs.
    It is minimally invasive, just a cut between ribs where the tools are inserted. But you’ll definitely be spending a couple days in a bed on the ward to make sure everything’s going well.

  20. PingPong Says:

    With the caveat, I don’t know anything else about you or your symptoms.

    I would say given the presence of a lobulated partially calcified pulmonary nodule and soft tissue in the anterior mediastinum you should at least get a PET scan and then figure out if you need a biopsy. I think the nodule is seen over the diaphragm on the 2006 chest x-ray (one view only).

    The differential is malignancy, hamartoma, carcinoid, metastasis, and a couple others including infection.

    I do needle biopsies and have had good success with them, yours would have a higher incidence of pneumothorax b/c of its location.

    also post the images as a dicom file and someone can download them and take a more detailed look at the data, the Quicktimes are really not good enough.

    Good luck.

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