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CT scan shows inflammation and fluid in airways. What could be causing this?

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Practicing since : 2003
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Hello, I would recommend taking a look at my profie information before answering my questions. My airways continually seem to get blocked - I have a proven shunt, but they cant seem to find where it is - I have had many CT's they just always find inflamation and fluid that is plugging things, my airways are constantly inflamed, however they have tried me with Asthma tests and found this not to be the cause, I know its likely becasue of the CVID, but I would just like to know if there is a physical malfunction that can occur, I have had chest pain for 8 years now, and my sats have dropped to 94 - each time they do a bronch they find blood and inflamation, sometimes there are infections but most times not - I was exposed to aebestos in my mid teens - but it feels as if fluid just backs up into my lungs.... when I breathe I can feel a clunk like a ball bearing is in my airway and it rises and falls but wont come out - I am getting pretty concerened because it is worsening and the side of my neck seems to bulge - the issue I have is scans only show inflamation - so does the biopsies - and a little squamous metaplasia - I ONLY have the problem when at rest for more than 1 hour, if excercising it ceases to hurt and I feel much better which apparently is the opposite of what should happen. I havea rash on my body and private parts - i have had every test known to man done - but what concerns me msot - is I now get dizzy when standing or lying down after being still for a while - it is as if something happens when I stand still and it builds up and irritates my airways
Posted Wed, 11 Dec 2013 in Lung and Chest disorders
Answered by Dr. Gyanshankar Mishra 6 days later
Brief Answer: CVID leads to recurrent infections. Detailed Answer: Hi, Thanks for posting the query, on XXXXXXX Since the query has been directed to me, I would like to give my opinion on it from Pulmonologist point of view. After going through your query, I would like to comment the following: 1. You have been worked up in detail and have been diagnosed with a lot of comorbidities and your symptom complex is a result of interaction of different disease processes in your body. 2. To summarise your diagnosis you seem to be suffering from CVID (Common Variable Immuno Deficiency Syndrome) with Psoriasis with gout with Arthritis (Psoriatic vs gouty) with Obesity with Obstructive sleep Apnea. 3.Most of your co morbidities are interlinked. Obesity and Psoriasis are the two risk factors that may cause Increased uric acid in your body (Gout). Gout and Psoriasis are two risk factors of arthritis in your body. Obesity is the single most risk factor of Obstructive sleep apnea (OSA) especially fat deposition rounf the neck in view of your history of neck swelling. There could be an additional component of obesity hypoventilation syndrome (ABG analysis for PaCO2 will help here). Memory issues can again be linked to OSA. Autoimmune phenomenon is known in persons with known allergies like you eg. penicillin allergy. 4. Coming to your respiratory system. You have been diagnosed with CVID. CVID is very well known to cuase recurrent respiratory tract infections which have led to your repeated episodes of coughing up blood. The recurrent infections associated with with CVID can be in a structurally normal lungs and hence the XXXXXXX ct scans. However the bronchoscopy showed inflammation and that signifies that there is inflammation of your respiratory lining epithelium which is very much dependant on immunoglobulins. There may be some ciliary motility issues associated with the inflammation of bronchi which leads to pent up secretions in the bronchi during early stages of infection. The point is to prevent these infective episodes since repeated infections will ultimately lead to development of bronchiectasis.Sterois and IV immunoglobulin therapy may be of help in reducing the inflammation. Prophylactic azithromycin will help serve the aim of preventing respiratory infection. The efficacy of pneumococcal vaccinations is doubtful in CVID hence vaccination will not be an effective option to be relied upon in this condition due to the deficient anti body production. 5. Since you have an enlarged liver with early hypoxemia, hepatopulmonary syndrome should be ruled out by seeing any postural fall of oxygen saturation. 6. For your obstructive sleep apnea , are you on CPAP? By ruling out asthma, I suppose your spirometry was normal? What are your serum IgE levels? 7. I suppose Extranuclear antigen profile for collagen vascular diseases has been done and is negative. Sarcoidosis and chronic hypersensitive pneumonitis must have been ruled out. ECG, 2D ECHO and stress test should have ruled out any cardiac involvement. 8. Possible causes for postural dizziness are local (ENT) eg meniere's disease, Cardiac or postural hypoxemia. 9. Associated asbestos exposure is a risk factor for such airway inflammation. Are you on any inhalers? Have you ever smoked. 10. Coming to your exertional dyspnea relieved on exercise, I would like you to undergo a full cardipulmonary exercise testing /if not possible, then a simple six minute walk test. Causes of exertional dyspnea relieved on exercise are commonly GERD (acidity), anxiety or panic. 11. Coming to your shunt test. Normal shunt fraction is less than 5 percent. The shunt tests are normally designes to quantify the shunt rather than localise it. The shunt fraction helps us know the fraction of blood escaping oxygenation.Common cause is consolidation,rarely, hepatopulmonary syndrome and AV malformation. 12. It most likely seems that on exercising, the warm air helps relieve the inflammed airways and hence helps you feel better. You may try home remedy with warm moist air inhalation from hot water to see if it helps. Such a phenomenon is sometimes seen in asthmatics. I hope I have answered your query. I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries. Regards Dr. Gyanshankar Mishra MBBS MD DNB Consultant Pulmonologist
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