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Chest X ray showing small uncalcified granulomata and minor fibrotic changes in upper lobe. What does it mean?

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General & Family Physician
Practicing since : 1986
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Hi Doctor, I did chest X-Ray for my wife, report showed that small uncalcified granulomata and minor fibrotic changes are present in the right upper lobe. The heart and left lung are normal in appearance. Impression: Evidence of previous granulmoatous diseas. Family doctor told that she had exposure for TB in past means old TB or inhale in body but not active. Could you please let me know is there any issue for getting residency visa for my wife in middle east. Although Doctor mentioned that she is healthy and not harm for other people.
Posted Sat, 23 Nov 2013 in X-ray, Lab tests and Scans
Answered by Dr. Haseena Hamdani 1 hour later
Brief Answer: She will not be denied visa for this finding. Detailed Answer: hi, Welcome to XXXXXXX As your wife is not showing any active lesions on Xray Chest, there will be no problem for her getting Visa for Middle East. Fibrotic changes tell us that it might be an old infection. Besides that, They do blood tests and number of other tests. If her blood tests are within normal limits, and she has no symptoms clinically, you need not to worry. Whenever we do any medical Examination, our diagnosis is usually based on correlating symptoms with physical examination, and laboratory tests. For Visa purpose we have to make sure that person is not having infectious and transmittable diseases, no mental disorders . As you mentioned in your question that according to her doctor , she is healthy and will not harm other people, I do not think that just on above X Ray finding, she will be denied Visa. Hope you got your answer. For any further questions, you may ask freely. Best Wishes Dr H Hamdani
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Follow-up: Chest X ray showing small uncalcified granulomata and minor fibrotic changes in upper lobe. What does it mean? 1 hour later
Do I need some other test to know the possibilty of any other disease? or confirmation that she had TB. 4 years ago, she had pneumonia, may be this is one reason for this report. Do you siggest we need some other test like skin test, blood test or CT scan to know what exactly this small uncalcified granulomata. I also want to know what does it mean small uncalcified granulomata?
Answered by Dr. Haseena Hamdani 1 hour later
Brief Answer: See below detail answer Detailed Answer: If there is a H/O Pneumonia, 4 years ago, most probably, granuloma has formed as a healing process after Pneumonia. Granuloma also can form after some yeast infection. There could be several other uncommon reasons for this Non calcified Granuloma, and there are number of tests, which can be done in a logical way determined by patient's high risk factors, symptoms, H/O smoking, size of nodules, change is size on interval X Rays etc. Calcified granuloma just confirms an Old infection and rule out Cancer. Non-calcified could be anything. Most definitive test would be Lung Biopsy or low dose CT Scan of Lungs, specially to rule out any possibility of Cancer. Possibility of TB can be ruled out by Tuberculin skin test, ESR, Sputum test for AFB etc, though It is not always possible to diagnose Tuberculosis by above test and we have to use our clinical acumen. If your wife has any other high risk factor, your doctor would have definitely advise her to go for further test, but it is good to be informative and to be proactive. If you have further question, you may ask with more description, X ary reports, or size of the nodule, age of your wife, occupational history, H/o exposure of active or passive smoking etc.
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Follow-up: Chest X ray showing small uncalcified granulomata and minor fibrotic changes in upper lobe. What does it mean? 17 hours later
Hi Dr. Haseena, I think I do not need to worry beacause my wife's all other lab reports are normal in range. 18 months ago she had cough for more than 3 weeks but that was not continue and no blood during coughing, she cured with using ordinary cough syrup. I asked my doctor to do a skin test, but she told me that lastly we confirm TB with X-RAY, first test is skin test. Because X-Ray showed this exposure then we do not need to back check. That's reason she referred my wife to TB clinic for treatment as preventive measure because currently she does not have this diseases. What's your opinion about all this. Will I go for treatment right now or wait for 1 or 2 years? Also do I request for other test or leave this decision to specialist?
Answered by Dr. Haseena Hamdani 3 hours later
Brief Answer: You can follow your specialist's advise. Detailed Answer: If your Doctor has confirmed TB on chest X Ray it is okay to go for treatment now. Sometimes even on clinical high suspicion, we can start Medicines for TB. Sometimes TB may not present as a typical picture of cough and blood in sputum, but may have some vague symptoms, of feeling tires, low appetite, reducing weight, etc. I hope your specialist will do everything needful for her. Dr H Hamdani
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