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X-ray report shows patchy homogeneous opacity in upper zone and suggest of infective etiology. Have chest pain. Guide?

DOCTOR OF THE MONTH - May 2014
May 2014
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Radiologist
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Hello Doctor,

My wife x-ray report shows patchy homogeneous opacity in the right upper zone and suggest of infective etiology. But her hemidiaphragms are normal in position and outline. Both the CP angles are clear. The mediastinum including hilla are normal. Trachea is central. Cardiac size and silhouette is normal and bony thorax is intact. She had tuberculosis twice in 2007 and 2009 and now at present she have chest pain while sneezing, coughing and movement of her right hand. I fear is it the tuberculosis hitting back to her again? Please advice.

XXXXX
Posted Sun, 28 Jul 2013 in X-ray, Lab tests and Scans
 
 
Answered by Dr. Vivek Chail 36 minutes later
Hi Mr XXXXX,
Thanks for writing in.

With the information provided, your wife 30 years of age has suffered from tuberculosis in 2007 and 2009.

I would like to explain Chest X XXXXXXX findings as you have mentioned:
1. Patchy homogeneous opacity in the right upper zone and suggest of infective etiology: This means there is some patch like formation in the right lung apex. Though no cavity formation is mentioned, it must be looked for. An infective pathology is always suspected initially in such patients as your wife.

2. Both the CP angles are clear: This is a normal finding.

3. The mediastinum including hilla are normal: This is a normal finding.

4. Trachea is central: This is a normal finding regarding airway.

5. Cardiac size and silhouette is normal and bony thorax is intact: This explains that the heart and bones are normal.

It would be great if you could send a digital format picture of the X XXXXXXX if possible.

Coming to your specific question.

Chest Tuberculosis is said to be inactive if there are no changes in Chest X XXXXXXX done 6 months apart.

Since possibilities other than tuberculosis must also be considered, starting a short course of antibiotics would be important while we still investigate for tuberculosis by various other tests.

Please look for the following and report to your treating doctor to investigate further for tuberculosis:
Cough present for more than a month.
Weight loss in last few days.
Unexplained continuous fever.

Please feel free to ask further questions.

Regards
Dr Vivek


Above answer was peer-reviewed by
 
Follow-up: X-ray report shows patchy homogeneous opacity in upper zone and suggest of infective etiology. Have chest pain. Guide? 23 hours later
Dear Doctor,

I am really grateful to you for your prompt response. Yesterday we went to Radiologist who has approved her X-Ray report and he said that the opacity doesn't seem to be TB but could be the previous germs of TB she had before, that could be infecting her again and suggested us to visit TB specialist and some antibiotics could be taken.So we went to TB and Chest disease specialist, he diagnosed her and asked us to do CT Scan and Blood Test as of now. We will do the scan and test today. Also we have done Sputum (AFB) Test and we got negative result.

Dear Doctor, I would just like to know, is it possible to completely kill the Tuberculosis bacteria and cure and never occur.I came to know that the germs is very difficult to kill and stays inactive or dormant but whenever the person becomes weak and his/her immunity becomes low it becomes active.
I asked your pardon as I could not send her digital format of X-Ray, as right now, I could not get the digital format.

Regards

XXXXX
 
 
Answered by Dr. Vivek Chail 3 hours later
Hi Mr.XXXXX,
Thanks for writing in with an update.

Your doctors are doing the right thing by recommending a CT scan of Chest for your wife. This will give us additional details about the pattern of the opacity and any smaller changes that are not obvious in X XXXXXXX Chest. Its good to know that Sputum for AFB is done and reports are negative. In many patients who have chest TB, the lung remains scarred and little fibrosis may be seen for a long time on X XXXXXXX even after treatment is complete. This is just like a cut wound on your skin which has healed a long time back but the scar is still seen.

Coming to your query on curative treatment of TB, you are right in saying that it is one of the tough bacteria and treatment for at least upto a year may be required in most patients. TB can affect any part of the body from head to toe. Since TB is commonly associated with chest infection, common people are not aware of this fact. Rigorous treatment is the first step towards treatment of TB. Subsequently, patient education and healthy living are stressed upon. TB germs are present in most communities and almost all of us are exposed to that. It is only the weak and people with immunocompromised status who show disease manifestations. Since Chest TB in chest can co exist with TB anywhere else in the body, any other relevant health problem may be discussed with the TB specialist and investigated if necessary. I would suggest that your wife gets used to healthy eating and takes care about regular fitness.

I am sure that your wife will lead a normal life once cured. In my own personal experience, I have met many people (including staff in medical jobs) who had the disease and are now completely treated and leading fit and healthy lives.

Hope your query is answered.
If you do not have any questions, I request you to please close this thread and post a feedback.

Let us hope for the best.
Wishing your wife good health.

Regards,
Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: X-ray report shows patchy homogeneous opacity in upper zone and suggest of infective etiology. Have chest pain. Guide? 26 hours later
Dear Doctor,

Thanks for your advice and appreciate your response. Waiting for the report now. Hope everything comes out normal.

I am closing the discussion now.

Many Thanks again.

Warm Regards

XXXXX
 
 
Answered by Dr. Vivek Chail 1 hour later
Hi Mr XXXXX,
You are most welcome and thank you as well.

Hope I have been able to answer your queries.
Hoping for the best.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: X-ray report shows patchy homogeneous opacity in upper zone and suggest of infective etiology. Have chest pain. Guide? 47 hours later
Dear Doctor,

I needed to follow up to you for some more queries, post receiving the chest CT Scan report of my wife, so I am re-opening this discussion again. I would like to give you all the details of the report as I don't know which may be important to you. I have also divided the report, number wise so that it becomes easy to refer to the problem in my queries.

Below is the report:

ULTRAFAST 64 SLICE MDCT: THORAX (HRCT)

Continuous spiral sections of the thorax were taken from the apices to the level of diaphragm followed by high resolution sections of the same region with multi planer reconstructions.

REPORT:

1) Patchy fibrotic changes are seen in the apical and posterior segments of right upper lobe with associated parenchymal architectural distortion and traction bronchiectasis.

2) Lung fields are otherwise normal in attenuation and show normal bronchovascular markings. No active parenchymal lesion is seen. No centrilobular nodules or consolidation is seen.

3) Mediastinum is central in location. Discrete tiny to prominent mediastinal nodes are seen, few of them showing calcification.

4) Trachea and major bronchi are normal in caliber. No intraluminal filing defect is seen. Both hila are normal in size and configuration. Hemidiaphragms are normal in position and reveal no significant abnormality.

5) No obvious plueral or pericardial effusion is seen.

6) Bones do not show obvious abnormality in the sections under review. The muscles and soft tissues of the chest wall do not reveal abnormality.

7) Visualized sections through the upper abdomen reveal mild hepatosplenomegaly.

IMPRESSION:

FIBROBRONCHIECTATIC CHANGES IN RIGHT UPPER LOBE - Post infective sequelae.
NO ACTIVE LUNG PARENCHYMAL LESION.
NO PLEURAL/PERICARDIAL EFFUSION.

Dear Doctor, the report marking for the above number points as okay and normal, I am relieved with that. But however, I am really worried for point number 1, 3 and 7.

For point number 1, as you 've said in your previous answer, the patients who undergoes through chest TB are left with scarred lungs and development of fibrosis.I am worried, will this fibrosis will lead to more acute problems in future of my wife such as difficulty in breathing,weakness, pneumonia or repeated infection etc. Does it lead to fibrosis inflammation in future or is it cancerous. I also want to know if a person have fibrosis can this be cured or healed completely or 'll it remain throughout the lifetime. Does it effect the life
expectancy of one?( I got in some forums in internet that it reduces the life of a person).

For point 3, if I am not wrong, is calcification of mediastinal nodes, means making the nodes inactive. Will it effect her if present or should it be removed through some treatment?

For point 7, can this enlargement be treated or will it become normal gradually?

Dear Doctor, I know I 've put up so many queries at one go and seek your pardon too, but I hope you 'll understand my situation that I am going through. I am really worried after receiving the report and your valuable suggestions or directions will really help me to go further for her right treatment.


Thanks & Warm Regards

XXXXX
 
 
Answered by Dr. Vivek Chail 5 hours later
Hi Mr.XXXXX,
Thanks for writing in with CT scan chest report details.

Please do not hesitate to clear your smallest doubts.

I will explain the entire report pointwise to the best of my ability:

1)     Patchy fibrotic changes are seen in the apical and posterior segments of right upper lobe with associated parenchymal architectural distortion and traction bronchiectasis.

This is related to findings which say that the affected upper lobe areas of the right lung are now seen as fibrosis. Fibrosis in lungs is a term used to describe scarred lung tissue while parenchymal architectural distortion denotes lung tissue structural damage and traction bronchiectasis is widening of the tiny pipes in the lung that carry air within different areas of the lung. All these findings are irreversible and will remain that way.

2)     Lung fields are otherwise normal in attenuation and show normal bronchovascular markings. No active parenchymal lesion is seen. No centrilobular nodules or consolidation is seen.

These findings describe that the rest of the lung tissue is normal. No tuberculosis or any infective activity is seen in the lungs. If this is understood clearly, it means the changes under 1) above are not so significant when we take the whole lung into picture.

3)     Mediastinum is central in location. Discrete tiny to prominent mediastinal nodes are seen, few of them showing calcification.

Here the presence of small lymphnodes have been described in the space between the two lungs, few of which show calcified appearance. I would have liked if they had mentioned the size of the biggest lymph node seen but any ways what is written suggests healed (inactive) lymphnodes. The healed mediastinal lymphnodes subsequently get totally calcified in most TB patients.

4)     Trachea and major bronchi are normal in caliber. No intraluminal filing defect is seen. Both hila are normal in size and configuration. Hemidiaphragms are normal in position and reveal no significant abnormality.

Appearance of major airways and diaphragms is described. These findings are completely normal.

5)     No obvious plural or pericardial effusion is seen.

No abnormal water or fluid collection is present in the space around the lung or heart.

6)     Bones do not show obvious abnormality in the sections under review. The muscles and soft tissues of the chest wall do not reveal abnormality.

The bones and muscles of the chest are normal.

7)     Visualized sections through the upper abdomen reveal mild hepatosplenomegaly.

The liver and spleen (organs in the abdomen) appear slightly enlarged.


Impression mentions past tuberculosis changes in right lung, top part. No active infection is seen at present.

Coming to your queries:

1.     For point number 1, as you 've said in your previous answer, the patients who undergoes through chest TB are left with scarred lungs and development of fibrosis.I am worried, will this fibrosis will lead to more acute problems in future of my wife such as difficulty in breathing,weakness, pneumonia or repeated infection etc. Does it lead to fibrosis inflammation in future or is it cancerous. I also want to know if a person have fibrosis can this be cured or healed completely or 'll it remain throughout the lifetime. Does it effect the life expectancy of one?( I got in some forums in internet that it reduces the life of a person).

Fibrosis is some sort of not fully functional lung tissue and does not allow much gas exchance. There is a possibility of secondary infection or re infection occurring in those areas in future. Please remember that this is only a rare event and will not occur if your wife takes prompt medical attention for any chest infection in the future. The fibrosis itself is healed scar. Very rarely can a scar in the lung transform into a tumor (I am still to see such a patient in my 10 years of practice). By affecting life expectancy, the forums must have meant the predisposition to secondary infections and thereby the need for regular medical care, which if delayed or ignored, can lead to a relatively decrease in quality of life. Let me assure you that those are in the books and need not occur with your wife.

2.     For point 3, if I am not wrong, is calcification of mediastinal nodes, means making the nodes inactive. Will it effect her if present or should it be removed through some treatment?

There is no need of getting them removed. They can be left there. There are plenty of lymphnodes in that region. For the time being you could ignore that. If a CT is done after let us say 5 years, the size and number can be compared to check for any new development, which is again less likely to happen.

3.     For point 7, can this enlargement be treated or will it become normal gradually?

This concerns the liver and spleen. It may require an ultrasound scan abdomen for confirmation and subsequent assessment by liver function tests. Spleen enlargement is mostly associated with infections keeping the problems faced by your wife in mind. The cause of liver enlargement can be better assessed through liver function tests of blood. This may have to do more with her general health than tuberculosis history.

Hope I have answered your queries.
Please feel free to ask any further questions.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: X-ray report shows patchy homogeneous opacity in upper zone and suggest of infective etiology. Have chest pain. Guide? 13 hours later
Dear Doctor,

I am so thankful to you for replying. Perhaps I should not be worrying much right now as concerning the point number 1 (fibrotic changes,parenchymal architectural distortion and traction bronchiectasis etc), they are not much significant since point number 2 i.e. her lungs is normal now.
However I 'll ask for suggestions and advice of what could be done about point number 7 (i.e mild hepatosplenomegaly) when I 'll visit the Chest disease and TB specialist on this Saturday appointment.

Dear Doctor, I didn't mentioned till yet, what led us to go for X-Ray checkup in first place. Actually she was having chest pain when she sneezes or coughs, when she moves her right hand or when she stretches her hand backwards. We initially thought to be some pain related to bone so we went to Orthopedic who advised us to do X-Ray. He gave us a short duration course of medicines such as Signo Flam, Raxclav, Rabifast and Allegra and my wife is currently taking all that. Even when we last visited the TB specialist he advised to currently take the medicines that Orthopedic has given for time being until the CT Scan report comes ( we will visit the TB specialist this Saturday with the CT Scan report).

My wife is currently feeling normal with very less chest pain now, but however it's still not completely gone. She complains of having mild pain sometimes like she complained today morning.

I suppose is it because of the infection she might be having now? Is she taking right medicines? Please advice.

Warm Regards

XXXXX
 
 
Answered by Dr. Vivek Chail 8 hours later
Hi Mr.XXXXX,
Welcome and thanks for writing in again.

I would like to clarify that the function of the area of lung having fibrosis is compensated by the rest of the lung which is normal. Hence there is no significant functional deficit in gas exchange in the lungs.

Please do discuss point 7) hepatosplenomegaly in detail with the TB specialist and if required have a consultation with the XXXXXXX medicine specialist or gastroenterologist.

Let me explain in short about the medicines prescribed.
1.     Signo Flam: This is a pain killer combination of aceclofenac and paracetamol and given for pain relief.
2.     Raxclav: I could not find Raxclav in Indian list of medicines. Instead there is Taxclav (please re confirm name) in India which contains cefixime and clavulanate Potassium and is an antibiotic preparation.
3.     Rabifast: This is rabeprazole which is a medicine to decrease stomach acidity.
4.     Allegra: This is fexofenadine and used as an anti allergic.

Your doctor has tried to take care of all possibilities towards cough, cold and fever. It could also have been a viral infection but then its always good to start on antibiotics to control any secondary infection because your wife has suffered from tuberculosis. The chest pain your wife is occasionally complaining could be because she is weak after the recent chest infection and may be due to repeated coughing.

It may be important to note that right now we are having monsoon and regular rains and that must be happening in Assam also. As a result I have come across many patients who are suffering from viral respiratory infections.

Hope I have answered your queries.
Please feel free to ask any further questions.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
Follow-up: X-ray report shows patchy homogeneous opacity in upper zone and suggest of infective etiology. Have chest pain. Guide? 13 hours later
Dear Doctor,

Thanks for the clarification. I am really very grateful to you for such a wonderful response for which I 'll always be indebted to you and this website. Your way of answering is really excellent, very detailed and clear and you keep note of all the aspects that I ask. I will recommend many of my colleagues in my office to come to this website for any medical suggestions.
I 'll discuss about point number 7 in deep details in coming appointment with the specialist and I hope my wife gets cured as fast as she can.

As of now, I am closing this discussion. I may reopen it again if required.

Many Thanks again.

Kind Regards

XXXXX
 
 
Answered by Dr. Vivek Chail 3 hours later
Dear Mr XXXXX,

Thanks for your faith in me and this website.
We are always ready to answer your questions.

Wishing you and your family the best of health.

Regards
Dr Vivek
Above answer was peer-reviewed by
 
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