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Have severe cough. Chest x-ray showed lung nodule. CT scan showed pleural thickening posteriorly. Prognosis?

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After having an ongoing, I would class as severe, cough for 3 weeks I was sent for chest X-ray, the following day was called back as it said possible 2cm lung nodule. Had a ct of chest don't the following day with the following finding:
Some minor pleural thickening posteriorly in the left hemithorax - at around the level of the hilum. Minor post inflammatory fibrotic changes are also noted in the most inferior aspect of the lingual of the upper left lobe. No intrapulmonary nodule is seen in the left upper zone.
Blood tests were also ordered with only the following elevation of white cell count - Eosinophils count 0.41 x10^9/L.
May be a coincidence, i had this same cough last october, but it got better, but still there just not as bad, night sweats have also returned. The left area, under my breast feels tight/sore and hurts when I cough or sneeze. General, when I lay down the cough worsens.
I am 34
Work in an underground coal mine although only underground 1 day a week, and have smoked until recently. No exposure to asbestos that I know of.
Any insight in this would be helpful.
Regards
XXXXXX
Posted Fri, 26 Apr 2013 in Lung and Chest disorders
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi XXXXXXX
Thanks for posting the query on XXXXXXX After going through the query, I would like to comment the following:

1. You seem to have been diagnosed with lung nodule on chest xray which later on turned out to be a pleural thickening with minimal lung fibrosis on CT.

2. You have history of coal dust exposure, a repeat episode of cough this year and a raised blood count. Was the total count increased or merely the eosinophil count was increased?

3. I would suggest you to get yourself evaluated with a Pulmonologist. Investigations that may be required are Pulmonary function tests with DLCO measurements if available and Serum IgE levels if eosinophil counts are increased. Bronchoscopy may be required at a later stage.

4. Dou you smoke? Do you have symptoms of cold like sneezing? Do you have fever at present? Dou have breathlessness on exertion or wheezing sounds occasionaly?

5. Possibility of obstructive airway disease with secondary infection is there. A course of antibiotics along with bronchodilators may be required at present.

6. Thus a clinical evaluation with Pulmonologist is required.

I hope I have answered your query. I will be glad to answer follow up queries if any.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
Follow-up: Have severe cough. Chest x-ray showed lung nodule. CT scan showed pleural thickening posteriorly. Prognosis? 45 minutes later
Thank you for your prompt reply!
To clarify for you, only the eosinophil count was elevated. The coal dust exposure I have, I think is minimal, 1 day per week for the past 4 years. Occasionally I am short of breath, and sometimes, maybe once or twice a fortnight have the feeling of struggling to fill my lungs when I take a deep breath. At present, I don't have a fever and also no sneezing. Just generally not feeling myself.
I did forget to mention earlier that in October last year I had a full body CT scan with contrast to rule out lymphoma due to prolonged and servere night sweats, nothing showed on this scan at all. As for antibiotics, when the cough began again, I had been seeing the dr daily for injections for and unrelated matter being recurring UTI infection that was not responding to any other form of antibiotic. When I went to the dr for the injection he commented on the cough and said if it were an infection that it would respond to the antibiotic, this didn't happen unfortunately. The antibiotic I was receiving by injection was Gentamicin. The only reason I was given this is that a blood test was done to see why the infection wasn't responding to all the other antibiotics, and the test came back that gentamicine (or that specific group) was the only one I didn't have a resistance to.
If there were some form of malignancy in the lung, would it have been picked up on CT ? As the CT report states minimal pleural thickening and Minimal lung fibrosis, would a specialist be more likely to not follow through with investigating the cause? Or is it something that I should asked to be diagnosed?
Thanks again
XXXXXX
 
 
Answered by Dr. Gyanshankar Mishra 1 hour later
Hi XXXXXXX
Thanks for the follow up query, After going through you follow up info, I woul like to comment the following:

1. A secondary airway infection is a possibility as culture dst of the sputum needs to be done in such cases which may help.

2. You need to visit a Pulmonologist and get yourself evaluated.

3. Investigations that may be required are Pulmonary Function Tests and Bronchoscopy.

4. There does not seem to be any malignancy as it is very unlikely for the CT to miss them.

5. The possibility here is obstructive airway disease or an eosinophilic lung disease. You may require inhaler therapy.

6. Also please consider to get yourself vaccinated with flu and pneumococcal vaccines.

I hope I have answered your query. I will be glad to answer follow up queries if any.


Regards

Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by
 
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