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
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