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What Does This HRCT Scan Report Indicate?
Question: My mother of age 69 had a HRCT scan of Thorax done recently.
The HRCT report (Plain and Contrast) shows :
Two fibrotic bands noted in right middle lobe & one in left lingular lobe.
Rest of the lung appears normal.
Given her history (see below), whats the disease and the future complications
expected ?
Background:
My mother had no symptom or history of asthma till ~8 years back (then ~60
years). She was, however, allergic to certain green vegetables and fruits:
Papaya, Baigan and ladies finger. Around that time, she started
coughing on daily basis and showed symptoms of allergy, e.g.,swelling of
eyes, for which local doctor treated her with anti-allergic tablets. Around
that time, she used to get mild asthma (for a few months), for which her
specialist doctor (treats her to control blood pressure and type-II diabetes)
started on Budesonide inhalation (200 micro-gram) 4 (later 2) times daily.
She responded to that and did not show further problems (except mild symptoms
during cough and cold once or twice in an year).
Before her bilateral total knee replacements an year back, PFTs were done,
which showed that her FVC is ~50-60% and FEV1/FVC is ~100% of what is
expected, indicating it to be a Restrictive rather than Obstructive lung
disease. Doctors expected some problems after operation and indeed she had
significant breathing trouble after a day of surgery. Her Oxygen saturation
was dropping to ~85% requiring Nebulisation and occasional Oxygen. She did
respond and the symptom went away after another 2 days (loss of blood during
operation perhaps contributed to it).
After her hospital stay she did not get any asthmatic symptom in the last one
year and typically keeps Oxygen saturation of 97-98% (measured a few times
spaced over several months). Recently, I checked her ability of walking for 6
minutes. She could walk about 260 metre. At the end of her walk her HR XXXXXXX
to 104 pm (was 70 at start) and oxygen saturation was 92-94%.
Since a restrictive lung disease (RLD) can deteriorate over time, she was
examined by a Pulminologist after her knee operation. The pulminologist
suggested further confirmation using DLCO and Body plethysmography. If RLD is
proven, HRCT with contrast was suggested to determine the type of lung
disease.
Her DLCO Single breath (Chest Research Foundation in Pune):
RV-He 1.03 L (predicted 1.97), TLC-He 2.52 L (predicted 4.7 L),
DLCO SB 2.33 (mmol/min/kPa) (predicted 6.93) and FRC-He 1.58 L (predicted
2.63) [In these tests her Hb is assumed to be 13.5, but tests done a few
months earlier had shown 11.7].
Her Body plethysmography (Chest Research Foundation in Pune) shows:
RV= 1.42 L (predicted 1.97 L) [72%], TLC 2.83 L (predicted 4.7 L) [60%], VC In
1.4 L (predicted 2.5 L) [56%], FEV1 0.96 L (predicted 1.98 L) [48%], FVC 0.98
L (predicted 2.4 L) [41%]
Her PFT shows FVC of 1.3 L (expected 2.1 L) [63%] and FEV1 of 1.1 L (expected
1.78 L) [60%] and PEFR (L/s) of 3.3 (expected 5.6) [60%].
Since these tests clearly shows her lung capacity is ~50-60% of what is
expected, HRCT of Thorax have been done a few weeks back (from XXXXXXX in
Kolkata).
The HRCT report (Plain and Contrast) shows (also described at the top):
Two fibrotic bands noted in right middle lobe & one in left lingular lobe.
Rest of the lung appears normal.
What can one conclude from it about the disease/problem and its prognosis ?
What does two fibrotic bands in right middle lobe & one in left lingular lobe
means in HRCT scan report ?
The HRCT report (Plain and Contrast) shows :
Two fibrotic bands noted in right middle lobe & one in left lingular lobe.
Rest of the lung appears normal.
Given her history (see below), whats the disease and the future complications
expected ?
Background:
My mother had no symptom or history of asthma till ~8 years back (then ~60
years). She was, however, allergic to certain green vegetables and fruits:
Papaya, Baigan and ladies finger. Around that time, she started
coughing on daily basis and showed symptoms of allergy, e.g.,swelling of
eyes, for which local doctor treated her with anti-allergic tablets. Around
that time, she used to get mild asthma (for a few months), for which her
specialist doctor (treats her to control blood pressure and type-II diabetes)
started on Budesonide inhalation (200 micro-gram) 4 (later 2) times daily.
She responded to that and did not show further problems (except mild symptoms
during cough and cold once or twice in an year).
Before her bilateral total knee replacements an year back, PFTs were done,
which showed that her FVC is ~50-60% and FEV1/FVC is ~100% of what is
expected, indicating it to be a Restrictive rather than Obstructive lung
disease. Doctors expected some problems after operation and indeed she had
significant breathing trouble after a day of surgery. Her Oxygen saturation
was dropping to ~85% requiring Nebulisation and occasional Oxygen. She did
respond and the symptom went away after another 2 days (loss of blood during
operation perhaps contributed to it).
After her hospital stay she did not get any asthmatic symptom in the last one
year and typically keeps Oxygen saturation of 97-98% (measured a few times
spaced over several months). Recently, I checked her ability of walking for 6
minutes. She could walk about 260 metre. At the end of her walk her HR XXXXXXX
to 104 pm (was 70 at start) and oxygen saturation was 92-94%.
Since a restrictive lung disease (RLD) can deteriorate over time, she was
examined by a Pulminologist after her knee operation. The pulminologist
suggested further confirmation using DLCO and Body plethysmography. If RLD is
proven, HRCT with contrast was suggested to determine the type of lung
disease.
Her DLCO Single breath (Chest Research Foundation in Pune):
RV-He 1.03 L (predicted 1.97), TLC-He 2.52 L (predicted 4.7 L),
DLCO SB 2.33 (mmol/min/kPa) (predicted 6.93) and FRC-He 1.58 L (predicted
2.63) [In these tests her Hb is assumed to be 13.5, but tests done a few
months earlier had shown 11.7].
Her Body plethysmography (Chest Research Foundation in Pune) shows:
RV= 1.42 L (predicted 1.97 L) [72%], TLC 2.83 L (predicted 4.7 L) [60%], VC In
1.4 L (predicted 2.5 L) [56%], FEV1 0.96 L (predicted 1.98 L) [48%], FVC 0.98
L (predicted 2.4 L) [41%]
Her PFT shows FVC of 1.3 L (expected 2.1 L) [63%] and FEV1 of 1.1 L (expected
1.78 L) [60%] and PEFR (L/s) of 3.3 (expected 5.6) [60%].
Since these tests clearly shows her lung capacity is ~50-60% of what is
expected, HRCT of Thorax have been done a few weeks back (from XXXXXXX in
Kolkata).
The HRCT report (Plain and Contrast) shows (also described at the top):
Two fibrotic bands noted in right middle lobe & one in left lingular lobe.
Rest of the lung appears normal.
What can one conclude from it about the disease/problem and its prognosis ?
What does two fibrotic bands in right middle lobe & one in left lingular lobe
means in HRCT scan report ?
Brief Answer:
She is mostly having age related restrictive lung disease.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Thanks for the detailed information.
She is mostly have age related restrictive lung disease.
She is not having ILD (interstial lung disease).
Two fibrotic bands can be an accidental finding. It is not suggestive of ILD.
Fibrotic bands can be seen due to old lung infection, allergy, chronic exposure to some chemicals etc.
Sometimes increasing age can also cause fibrotic bands.
So in my opinion, no need to worry for fibrotic bands.
Her detailed PFT is suggestive of restrictive lung disease. But her six minute walk and oxygen saturation are good.
So possibility of age related restrictive lung disease is more.
And prognosis is good in this type of disease.
Do following things for better prognosis.
1. Chest physiotherapy and deep breathing exercises. These will improve her lung functions.
2. Start inhaled bronchodilators and inhaled corticosteroid (ICS). She needs bronchodilators along with budesonide.
3. Give her adult Pulmonary vaccines like pneumococcal and Influenza vaccines to prevent recurrent respiratory tract infection.
4. Start Pulmonary antioxidants like N acetyl cysteine (NAC) and picnovit. These are also good.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother. Thanks.
She is mostly having age related restrictive lung disease.
Detailed Answer:
Thanks for your question on Health Care Magic.
I can understand your concern.
Thanks for the detailed information.
She is mostly have age related restrictive lung disease.
She is not having ILD (interstial lung disease).
Two fibrotic bands can be an accidental finding. It is not suggestive of ILD.
Fibrotic bands can be seen due to old lung infection, allergy, chronic exposure to some chemicals etc.
Sometimes increasing age can also cause fibrotic bands.
So in my opinion, no need to worry for fibrotic bands.
Her detailed PFT is suggestive of restrictive lung disease. But her six minute walk and oxygen saturation are good.
So possibility of age related restrictive lung disease is more.
And prognosis is good in this type of disease.
Do following things for better prognosis.
1. Chest physiotherapy and deep breathing exercises. These will improve her lung functions.
2. Start inhaled bronchodilators and inhaled corticosteroid (ICS). She needs bronchodilators along with budesonide.
3. Give her adult Pulmonary vaccines like pneumococcal and Influenza vaccines to prevent recurrent respiratory tract infection.
4. Start Pulmonary antioxidants like N acetyl cysteine (NAC) and picnovit. These are also good.
Hope I have solved your query.
I will be happy to help you further.
Wishing good health to your mother. Thanks.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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