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Suggest Treatment For Cough And Cold

Posted on Wed, 7 Jun 2017

Question: Hi

I had a bad cold and cough in early January. The cough was so bad I felt pain in ribs on both side.

I had a bone scan in early feb that showed focal
Acitivity in one anterior rib. This was followed by a chest ct without contrast which showed a sclerotic lesion on this rib. The lesion is approx 1.8cm. No acute fracture is seen though

I initially assumed this was related to my horrible cold. I have to have a repeat ct of chest in a few weeks to look at lesion again

What could this sclerotic lesion be? What is the doctor looking for in the next chest ct? Change in size?

Answered by Dr. Vivek Chail (33 minutes later)

Brief Answer:
It is likely a healing rib fracture due to coughing

Detailed Answer:
Hi,
Thanks for writing in to us.

There is a possibility that the sclerotic lesion is due to healing fracture in the rib which might have been due to coughing.

Your doctor wants to compare and take note of the progress of the sclerotic area if any.

In the CT we can know change in size, change in density and any new areas of sclerosis.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Vivek Chail (49 minutes later)

Ok. Is there a reason that the sclerotic area wasn't called a healing rib fracture. Why would radiologist call it a sclerotic lesion? I'm assuming he couldn't tell it was a fracture if it actually is one. And is this normal that a healing fracture is hard to differentiate between other things?

Thanks

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer:
Since there was no obvious break in bone, the term fracture was no used

Detailed Answer:
Hi,
Thanks for writing back with an update.

A sclerotic area is a sign of increased calcium deposits. There is increased calcium deposit over fracture healing areas. A fracture comment is made where there is a break in the cortex of bones, if there is no break then we do not use the fracture. There are fractures called stress fractures in which there is no obvious break of bones in early stages but the sclerotic changes are visualised later.

There are benign conditions other than healing fractures where well defined sclerotic changes in the bone is visualised and the commonest cause is a bone island. These are small areas of sclerosis in the bone. However bone islands are not always active on a nuclear bone scan.

Therefore a sclerotic lesion is a general term for increased calcium deposition. Due to your clinical history, I thought of sclerotic changes secondary to healing stress fracture in the rib.

There are many other causes for sclerotic bone lesions and the list is long. It is difficult to make a confirmed diagnosis only by one CT scan and follow up imaging helps.

Hope your query is answered.
Please do write back if you have any doubts.

Regards,

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Vivek Chail (9 hours later)

Ok. That makes sense. So if this is in fact a stress fracture the fact that a fracture wasn't obvious isn't unusual? Is that correct?

What would I hope to see on the ct scan now if it is a healing fracture? Would the lesion or sclerotic area be smaller?

Thanks for all your time doctor.

Answered by Dr. Vivek Chail (2 hours later)

Brief Answer:
It should be nearly the same this time for a fracture

Detailed Answer:
Hi,
Thanks for writing back with an update.

A stress fracture occurs in a bone which is weak and under stress. It takes a longer duration to develop due to repeated activites like running, exercises and coughing. This is a slow process and if neglected then will show up as a break in bone which is the usual fracture.

If it is a healing fracture then it is expected to form a localised sclerotic process and should not differ much from the previous scan. It might not get smaller but should not increase much in size in a fracture.

Regards,

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Vivek Chail (14 days later)

Hi Doctor

I had my repeat ct scan of chest a few weeks ago. It showed sclerotic lesion unchanged. What does this point to? I have to have a repeat ct chest in 3 months to check it again. If the lesion is unchanged does it mean it could still be a fracture? Or more likely something else?

Thanks

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer:
An aggressive lesion like infection or cancer is less likely

Detailed Answer:
Hi,
Thanks for writing back with an update.

Your repeat CT shows that an aggressive process like infection or cancer is less likely.
Therefore it might be a slowly healing fracture or a benign lesion.

Also I guess that there are no associated changes around the area of sclerosis and there are no new changes visualised.

Regards,

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Vivek Chail (48 minutes later)

It just said unchanged. No other osseous lesions seen. If it is a fracture will it look different on ct in3 months? Smaller?

Answered by Dr. Vivek Chail (8 hours later)

Brief Answer:
Unchanged means a stable lesion.

Detailed Answer:
Hi,
Thanks for writing back with an update.

Unchanged means a stable lesion.

In small fractures it can stay unchanged in 3 months and in large fractures there can be increased in calcification which is visualised in the scans and then it appears similar to normal bone in few months.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (2 hours later)

Ok. If it was a fracture would the next scan likely show it smaller? Or gone? Or more sclerotic? The area is 1.8cm

Answered by Dr. Vivek Chail (16 hours later)

Brief Answer:
Can you upload a picture of the sclerotic rib from the recent CT scan

Detailed Answer:
Hi,
Thanks fr writing back with an update.

A fracture heals slowly and there is calcium deposition which makes it sclerotic. It can take 2 to 6 months for a fracture to heal significantly and then the area shown normal mineralisation.

With increase in duration and after some months, the sclerosis will fuse with the adjacent area.

Can you upload a picture of the sclerotic rib from the recent CT scan in bone window settings for me to see? That will help me to give a better opinion.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (3 days later)

I should be getting the CD today. How can I upload it?is there an app?

Thanks

Answered by Dr. Vivek Chail (9 hours later)

Brief Answer:
Please upload the complete CD to google drive or dropbox

Detailed Answer:
Hi,
Thanks for writing back with an update.

Please upload the complete CD to a file sharing facility like google drive or dropbox and send me the sharing link in a follow up.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (5 days later)

https://drive.google.com/drive/u/2/folders/0BzrlFIaOHy8gMlN3QUtTblQ4dVU

I could only download some of the images. I dont know if the 6th right anteriolateral rib is on these or not.

Answered by Dr. Vivek Chail (4 hours later)

Brief Answer:
Kindly permit access to google drive

Detailed Answer:
Hi,
Thanks for writing back with an update.

The link above takes me to google drive and I have been asked to request access. I have sent a request from my google id.

Kindly permit access so that I can vies the images.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (9 hours later)

Ok. All set Thanks

Answered by Dr. Vivek Chail (3 hours later)

Brief Answer:
The lesion is relatively well defined but needs follow up

Detailed Answer:
Hi,
Thanks for writing back with an update.

The sclerotic area in the rib is relatively well defined and not the usual neoplastic lesion. To me it looks more benign at the moment. There are no associated findings around the sclerotic area. Keeping in mind these features, a healing fracture is a likely possibility.

However we cannot ignore it completely and a review is surely needed to confirm it as a benign lesion.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (28 minutes later)

Ok. So the next step my doctor is recommending is another ct chest in 3 months. Does this sound like a good plan? She offered to do a bone scan sooner if I was worried but thought it wouldn't be specific enough.

Answered by Dr. Vivek Chail (18 hours later)

Brief Answer:
Your doctor has a good plan for you

Detailed Answer:
Hi,
Thanks for writing back with an update.

The plan offered by your doctor to do a review CT scan after 3 months is good. Any improvement or stable appearance will be obvious in your next scan.

Bone scans will tell you the activity in the area and if there has been any increase. Bone scans are not always specific as you rightly pointed.

Regards,

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (4 hours later)

What would I expect to see on the next chest ct if this is a healing fracture? Will it look smaller? More sclerotic? Same? Thanks for all your help Doctor

Answered by Dr. Vivek Chail (10 hours later)

Brief Answer:
If it is a healing fracture then most likely it will stay the same.

Detailed Answer:
Hi,
Thanks for writing in.

If it is a healing fracture then most likely it will stay the same.

Regards,

Above answer was peer-reviewed by : Dr. Remy Koshy