Dr. Parveen Yograj (General Surgery) needs a second opinion on this medical case.
67 years,old male with history of loss of appetite since,last 3 months- On examination- Pallor + , right cervical lymph node mass , Hb - 5.4 after 2 units of blood transfusion. Earlier 10 days,back Hb was 4.2 gm% . ESR - 142 X- RAY CHEST COPD changes and bilateral minimal pleural effusion. F.N.AC of neck lymph node mass only shows narcotic material- AFB staining negative. ULTRASOUND ABDOMEN- Normal except.mild splenomegaly . CECT chest - Bilateral pleural effusion with basal atelectasis .Significantly heterogenously enhancing medistinal lymphadenopathy . Considering medistinal lymphadenopathy and significantly raised ESR - 142 . Two possibilities are there 1.Tuberculosis 2.Lymphoma - could be DLBCL Considering the Lockdown- patient was investigated in private set up - what next to differentiate between tuberculosis or lymphoma. Empirically, I have started ATT . Only good centers can do CT guided medistinal lymph node biopsy - to rule out Lymphoma .Do bone marrow examination have a role . Even s.protein electrophoresis was done to rule out multiple myeloma which was normal
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