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Chest Xray and CT interpretation - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Very Good Posted in: X-ray, Lab tests and Scans
Answered by

General & Family Physician
Practicing since : 2004
Answered : 37 Questions
User :   Hello Doctor,38yr old male caucasion - Australian.I have had undiagnosed breathing problems and chest pain for a few years and have had Spirometry, Cardio, ECG tests etc.I am currently in hospital for an unrelated matter (infected arm after surgical drainage of a bursa).I was sent for Xrays of my chest to rule out pneumonia - they found something and the Doctor has asked for a second Xray.I wont get to see the doctor for a little bit - so can you please explain to me what the below means? "There is some silhouetting of the left hemidiaphragm posteriorly on the lateral projection and there is some streaky opacity within the left lower lobe suggestive of evolving consolidation. There is no convincing effusion. Cardiac size and configuration are within normal limits. Incidental note is made of incomplete fusion at the first and second thoracic neural arches". - Could this be causing my chest pain - is it serious? I did have a ct done not so long ago which found fluffy infultrates posteriorly in the left lower lobe
Doctor :   Hi
User :   Hello - I will let you read
Doctor :   I am Dr. xxx
Doctor :   Yes thank you
Doctor :   The chest pain can be due to pneumonia
User :   is it possibly cancer growing?
Doctor :   The finding on Xray says there can be a posibility of pneumonia
Doctor :   Were you diagnosed to have cancer?
User :   no
Doctor :   Were you a smoker?
User :   yes - but not a huge smoker and havent foora long time
User :   well for 1.5 years
Doctor :   When did you quit it?
Doctor :   Do you have fever and cough?
User :   NO - and this bretahing issue has been going on for a long time, at first it ws just hard to breathe when sitting still
Doctor :   Do you lose weight and no appetite for the last few months?
User :   no
User :   can you break down each bit for me?
User :   I would really like to understand and dont want to walk away thinking maybe cancer maybe pnuemonia
Doctor :   Xray cannot decipher a diagnosis nor a CT scan
User :   oh - so it could be either?
Doctor :   The symptoms, risk factors, physical signs noted by doctor and radiology helps in bringing out a diagnosis
User :   whats the thing about the incomplete fusion of first and second thoracic nueural arches
Doctor :   That has nothing to do with your current complaints
User :   but surely it points to one over the other?
Doctor :   Given your history I would go in favor of Pneumonia over cancer
User :   are you sure the incomplete fusion could not be causing rib pain
User :   wouldnt I have a fever for pnuemonia over 3 years
Doctor :   That too Pneumonia is not quite established
User :   ???
Doctor :   What is your age?
User :   38
Doctor :   The chances of cancer at this stage is remote
User :   so the fusion thing cant cause rib pain
Doctor :   Now coming to the findings on Xray and CT, both of them are not exact to relate to Cancer or Pneumonia
User :   so where do i go to from here
User :   ok
User :   pls explain
Doctor :   You have to repeat the CT scan that can increase the probability of a diagnosis
Doctor :   by your examining doctor
User :   whats the point of the xray then - if it cant tell the difference?
Doctor :   Xray is the first investigation
User :   how many times is it safe to have a CT scan?
Doctor :   There is no specific limit mentioned
Doctor :   If it is important then it is ordered
Doctor :   if it is helpful for the benefit of the patient, then only ordered
User :   they hvae asked for second xray for comparison
Doctor :   Yes they might ask for a repeat Xray again if not CT scan
Doctor :   how the lesions in the lung progress
User :   so i dont know anyhting more...bugger
User :   why does the front of my ribs hurt - when it is the rear lower that seems to be affected
User :   why des it feel better after I excercise
User :   would this explain my lymph nodes swelling up
Doctor :   Where are the lymph node swelling?
User :   arm pits - currenty bad becasue of the arm infection but they keep playing up - had large ones around the XXXXXXXX as well
Doctor :   Since how long they are enlarged in the carina?
Doctor :   *at the AAAAAAA
Doctor :   any attempts done to do a biopsy?
Doctor :   Any attempts done to refer to a Rheumatologist
User :   that was found about 2 years ago
User :   I have really bad joint pain all the time
Doctor :   if it is a immunological problem
User :   psoriatic arthritus they think
Doctor :   Ok
Doctor :   It can be related to chest pain
User :   soI dont think pnuemonia affects lymph nodes?
Doctor :   it can
User :   I see - last CT said it might be inflamation
Doctor :   Pneumonia has inflammatory signs
User :   Ok so your thoughts???
Doctor :   My thoughts are
Doctor :   1) A re referral to Rheumatologist
Doctor :   2) HRCT scan
Doctor :   3) Institute empirical treatment in terms of Pneumonia and wait for 5 to 7 days
User :   ok thanks a lot
User :   what is empirical treatment?
Doctor :   Locally followed antibiotic regimen
Doctor :   till a definitive diagnosis or treatment plan
Doctor :   is found
User :   I am now on anibiotics for next 6 weeks
User :   I have a referal for rhuemo
User :   if its cancer - would that be a bad place to get it?
Doctor :   ok continue
Doctor :   It cannot be cancer
Doctor :   But make sure you do not smoke
User :   why do you say that?
Doctor :   The points against cancer are
Doctor :   1) Age
Doctor :   2) short history of smoking
Doctor :   3) No confouding signs or symptoms
User :   ok thanks doc
Doctor :   Hope it is helpful
Doctor :   Bye for now
User :   cheers
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