Radiology/Bony Sclerosis on CT
On a recent chest CT, I have a few questions. For the most part, the results make perfect sense. It doesn't answer what the problem is but, it rules out what the radiologist was tasked to look for, pulmonary embolus, and deep vein thrombosis. Here are the basic portions of the CT report:
Clinical findings: 41, Shortness of breathe, cough and history of breast cancer.
Findings: (in part) A 6mm area of bony sclerosis proxal right femur.
Impressions: Negative for findings of pulmonary embolus or deep vein thrombosis and no acute findings.
The clinical findings regarding a history of breast cancer is incorrect. I have had skin cancers, early cervical cancer and a breast biopsy for which there is a bb in my chest marking the position. But, I have not had breast cancer.
Now, I did find this article on differential diagnosis of bony sclerosis, as I was curious. I don't think that most things fit. http://www.rad.washington.edu/academics/academic-sections/msk/teaching-materials
. And, I would tend to think that metastasis is unlikely. I have been very lucky and caught things early. I do have to be vigilant with my skin but, I would think this is unlikely. I also
Know that I have never had trauma on my thigh.
So, here are my questions:
1. Can a radiologist tell if a bony sclerosis is malignant or benign, simply based on te appearance on a ct scan?
2. Should I conclude that the statement "no acute findings" means that this bony sclerosis is not a concern, or that it is slow growing? Or that it is not the cause of my cough and shortness of breath, which we were
Searching for the cause?
3. It's unusual that the radiologist is bringing up breast cancer. (Incorrect.) But, this was surely not part of the information sent from my pulmonary doctor ordering this scan. Should I conclude that the doctor is just wrong, or there is something allerting him to cancer and that is why this was included?
4. Is this something that I should follow up on? Or bring up to one of my other care providers? I have had total body scans and bone density scans in the past, and this was not present.
5. I have had skin cancers over the last 12 years. I had one anomally that was not malignant, but was deemed "severe melanacytic atypia" that was growing very very quickly and extended to deepest layers of the skin, removed from my right side, just over my pelvic bone,
low waist in the front. This was in 2005, I think. Most recently, I have most recently had a infiltrative basal cell removed from my lip/ vermillion lip, last fall and had swollen lymph nodes, a cough, shortness of breath and more progressively getting worse. I have also had trouble swallowing. I also just had a barium swallow and am waiting on results. (But, again, I would describe my history as lucky, provided I keep on top of it and am vigilant with follow ups.)
6. I have not had any pain in my hip. I have had some severe shooting pains in my right foot/leg after prolonged car rides but, It's not anything I thought warranted medical care.
7. My bloodwork was unusual. But, I attributed this to the steroids given just prior to my scan,
Due to iodine allergy. Most noteably: co2- 19 (low), WBC-15.6 (high), Neutrophil-96% (high), , Lymphocyte-4%(low) , Basophil, 0% (low) , eosinophil- 0% (low). Also, my lung function testing was abnormal relative to what it was 2 years ago, hence the reason I got sent for a
Ct and barium swallow. Apparently, my diffusion rate was low.
I look forward to your thoughts. Thank you.
Thanks for details and the info.
I would say that given your history, you may have had CTs before this one. Perhaps a PET/CT? If you do have prior CT that cover the same region that would be helpful and I would make the comparison CT available to that radiologist so they can compare and put an addendum to the report. Also, I can tell you that 6mm sclerotic area in the femur is not that concerning, most of the time, it turns out to be a "bone island", which is basically ossified bony matrix where it shouldn't be ossified...not a big deal. Actually, if you ever had a regular xray of your leg, may be that focus was there before as well.
so on to your questions:
1. There are some characteristics of the margins that may allow for some suspicion to be raised regarding malignant potential of the sclerosis but overall, it is difficult to distinguish bening from malignant. We mostly rely on history provided, location of the lesion, number of lesions and certainly as I mentioned, internal qualities to the lesion itself.
2. No acute findings doesn't mean much. I would think that if the radiologist was concerned about the 6mm sclerosis, he/she would recommend additional work up or follow up to determine stability. I would think that this phrase referred to overall exam, especially as it relates to your symptoms at the time.
3. Agree re discrepancy of breast cancer. Can't add much more. I think it is a discrepancy in history provided to the radiologist, perhaps somewhere along the lines of papers or it is an error in the report. I wish it had not happened but I would not be concerned about it. I highly doubt that something was concerning, otherwise it would be in the report.
4. If you have comparison studies that include your femur then someone should look at them; if not, I would probably get an xray in 1-3 month and see if the focus is stable.
Hope this helps.