Suggested course of action for Mediastinal Lymphodenopathy?
Age 54

A Current diagnosis

I have done a Chest X ray followed by a CT Scan

Lymphnodes are enlarged and the conclusion from CT Scan is that it is Mediastinal Lymphodenopathy

I have also done ACE test and the reading is 47 mg/IUL

I have no symptoms of pain , coughing, weight loss ; though I get tired nowadays may be more I am not walking regularly and not fit

B Other parameters

Iam 54 yrs old male - height 5' 10" ,weight - 88 kgs

I am a hypertensive – take daily 2 Aten 25 tablets and 1 Telma 40
I took a MRI in oct 2007 – showed lacunar infract --take Clopilet 75 mg

My cholestrol levels have been high --My Triglyceride levels are elevated -above 200 – I take Storvas EZ

My Uric acid is at 8 ,Urea at 40 and S.Creatinine at 1.7 - have been asked to control this

C Suggested course by Chest physicians ; for A above

1 Some specialists advise that I should do a CT guided biopsy –

Radiologist had advised that Contrast had to be used to be able to locate the node tissue , which in my case is not advisable due to creatinine levels.

Therefore Chest physicians advise that success not guaranteed as the lymphnodes in lungs may not be located easily –( they could , if possible locate a node in the neck )

2 Another opinion is that we leave it as it is and do a scan after 3 months ( Chest X Ray one year back also showed some opacity and since there are no symptoms , may be there is no major cause for worry )

3 Do a PET CT scan

D Questions /advise

What would you suggest as the course of action ?

Is PET CT a good procedure establish with certainty whether it is Sarcoidosis or any other disease

What could be the underlying disease ( TB, Infection, Lymphoma , Sarcoidosis ) based on A and B above

Appreciate your medical advice