ACK!!! | Arthritis Information

Okay, this whole "test results online" thing is cool, and I would fight to keep it, but ACK!

So I have had intermittent chest pain, probably RA related--probably costo, we're not sure. Not huge scary thing but annoying and I want to figure it out eventually.

So RD ordered a chest x-ray at the last visit. I got an email from him following that said something like, the x-ray is clear, chest pain is probably related to RA inflammation in some way.

So then today my x-ray report showed up online:

The lungs are clear. The cardiothoracic ratio is normal. Sequela of granulomatous disease is noted.

IMPRESSION:

No active cardiopulmonary findings.

END OF IMPRESSION

ACK! "Sequela of granulomatous disease is noted." I looked this up, and it looks like that could be just about ANYTHING. I am happy that my heart is okay but ????

The whole histo thing has me worried. But I have no fever, no infection that I know of, WBC was normal recently. Will continue to google...and ask more at my follow up I guess...I figure if it were something huge he would have had me do something soon.

But now I am reading more about histo...!?!??!?!?!?

Meant to add...I just walked on the treadmill for about 30 minutes, despite having a cold...I am feeling much better since Humira. Energy level is up. Had weird dizziness after Humira shot but that isn't going on right now... not like I feel like a million bucks but all in all, I've been much worse...and I had some right sided chest pain today, but very light (GERD like) and I haven't been having any at night....KatieG2009-04-20 19:37:28But now I am reading things about lupus (but I'm ANA fine), TB, general autoimmune thing that is called granamawhatchamacalit, pneumonia. I have NEVER had pneumonia and never even an infection in my chest (that I know of?). No cough. Hopefully I am overreacting. I am seeing the dermatologist on Thursday about being itchy and you better believe I am going to corner him and ask him all sorts of non-dermatological questions :)I found this to be quite helpful (JK of course)

Table 1

Broad differential diagnosis of granulomatous lung disease

Infection

Bacterial

Fungal

Parasitic

Pneumoconiosis

Aluminum

Beryllium

Cobalt

Hypersensitivity pneumonitis

Drug effect

Malignancy

Lymphoma

Lung cancer

Eosinophilic pneumonia

Aspiration pneumonia

Intravenous talcosis

Sarcoidosis

Connective tissue disorders^a

Vasculitis syndromes

Wegener's granulomatosis

Churg–Strauss syndrome

Immunodeficiency states

Common variable immunodeficiency

Chronic granulomatous disease

Incidental with no clinical importance

So the little "a" by "connective tissue disorders" says "see table 3." Below is Table 3. It looks like this may just be a symptom of RA (particularly as I have no fever, coughing, etc.?)

Table 3

Lung pathology findings in connective tissue disorders

	RA	SLE	SSc	PM/DM	SS	MCTD	AS	IBD	PC
Pleuritis	+	+	+	+	+	+	+
Diffuse alveolar damage	+	+	+	+		+
Usual interstitial pneumonia	+	+	+	+	+	+
Organizing pneumonia	+	+	+	+	+	+		+
Granulomatous pneumonia	+	+				+		+
Lymphoid infiltrates	+				+	+
Rheumatoid nodules	+					+
Diffuse hemorrhage	+	+	+	+		+		+
Eosinophilic pneumonia	+					+		+
Vasculitis	+	+	+	+	+	+		+
Bronchiolitis	+	+		+	+	+		+	+

RA = rheumatoid arthritis, SLE = systemic lupus erythematosus, SSc = scleroderma, PM = polymyositis, DM = dermatomyositis, MCTD = mixed connective tissue disease, AS = ankylosing spondylitis, IBD = inflammatory bowel disease, PC = polychondritis.

THANK YOU FOR LETTING ME TALK TO MYSELF ONLINE! :)

Katie, you should be asking your doctor these questions.

I know, I feel like I've been bugging him a lot lately, between the itching (Derm on thursday, finally!) and the chest pain (still undiagnosed). Ridiculous, right? I just need to ask...

The radiology report was silent about it, so I won't freak out...it is hard because my job is all about investigating and figuring things out so all this makes me crazy. My family paints me as a hypochondriac...and I am, in part...but really I just HATE unanswered questions. I never had the true hypochondriac panic about things until well into RA diagnosis, after YEARS of having un-dx symptoms. Oh well. This is a horrible forum for me on that level, but also wonderful as well, to just put it out there and vent.

Isn't it crazy that I am an attorney, and I am worried to ask my doctor about something that is on my x-ray report? I talk big and can be pushy in a professional context but I am a people pleaser at heart...also don't want to get labelled by doctor as worry-wart...probably warranted though....

I totally understand. I had a small mole removed from my lower eyelid when I was 8.5 months pregnant with our younger son (and 1 month after DH had a near-fatal heart attack). I didn't think anything of it, but the dermatologist said it looked like skin cancer. He tried to reassure me that it was "only" basal cell carcinoma, and that it was pretty much a non-issue, but of course all I heard was "yadda yadda yadda CANCER." OMG I freaked out for the next two weeks. Pathology came back - it was definitely basal cell carcinoma, but the margins were clear, and after more research (and reassurance) I finally decided that we had far more important medical concerns to worry about. It's been 9 years and I've not had any more problems with BCC, though I do make sure to cover up if I'm going to be out in the sun for more than an hour or so.

I can't imagine dealing with that while pregnant! I had a big mole removed from my scalp a couple of years ago. They cut it out and cauterized rather than doing stiches = GROSS. It was not melanoma but was severely dysplastic or something but the margins were fine and now I just have a quarter sized bald spot. Oh well. It's mostly gross when it gets gooped up with things. Yes, it is that gross, and it feels like I am touching my brain when I touch in there...of course I'm just touching my skull minus a layer of fat but it is REALLY GROSS. I haven't had to have any other moles removed, despite having many (but I've been pretty good about sunscreen my whole life). I can say, the darn thing did look a LOT different from my other moles...it was FLAT, much bigger than others, and multi-colored. It had a white center which is apparently not good. Glad I got it checked, everyone should go for a mole check! I am hoping they can fit my annual mole check in with my "I'm itchy" visit...alright, I am going to bed. Had hoped to stay up and work and got TOTALLY distracted by that...

Katie, I agree with Jas, give him a call... that is what you pay him for! I know how you feel with the whole chest pain/weird things in x-ray stuff. I use to worry and worry but now... well, I am doing all I can and as long as my pulmonologist says "Don't worry.", well, who am I to argue? I just live with the pain I have, much like I do with the chronic pain in my feet. I do know the worry will make things worse... so try not too.

I hope your dermatologist finds the answers to your itchy stuff too. Talk about making your life miserable! just chiming in with the smart peoples here... call your RD..

and don't forget to update us!!

best to you

Thanks guys! I just emailed him through their system. It's one of those things were you are like...well of course he read that part and didn't mention it because it's fine...but what if he just heard from the radiologist, her heart is fine, and didn't read that part...and hasn't yet followed upetc....he has been pretty good about responding to my emails, so I am hoping to hear from him soon! I basically just asked what is this and do I need to follow up now or in 3 months, it sounds worrisome...don't freak out many people will show signs of granulomas on xray. a very common cause in the midwest/southern US is histoplasmosis a fungal infection which you may have never known you had. the scarring in 99% of cases is harmlessYou hit the nail on the head! His response:

A high percentage of people in this region have contracted histoplasmosis, a fungus infection, at some time in their lives. For almost all, it is a mild infection but leaves characteristic changes in the lungs called granulomas, which cause no problem other than showing up on chest x-rays.

Seriously, I have so many medical records from 10 years ago that are in the landfill, never to be seen again, but sometimes having online access to all of my medical records is not a good thing.

I guess I feel better, but it was stressful to read that, especially since the whole chest pain issue hasn't been resolved. Oh well...deep breaths...moving on with my day....

I think I need some sort of buddy system for logging into my Vandy account, and should be prohibited from doing so at 10:30 pm :)
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