Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Thanks for writing in to us. I have read through your query in detail. In our country, any calcific foci in chest x ray must be investigated for TB first. It may be possible that you never had TB but still have the healed granuloma in chest. It would be great if you can send me the X ray image by taking a picture and attaching it with your query. I would like to know the reason why you got chest X ray done and if you have had any chest infection is the past. Also you may send in scanned copy of your TB test because there are many tests for TB. The main symptoms of TB are low grade continuous fever and weight loss. In chest TB patients usually have cough for 2 months which does not respond to medications. Please do write in with an update. Regards, Dr.Vivek

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Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, You are welcome and thanks for writing back with updates. I see that you have taken trouble to get a good picture of the X ray chest, it does show some doubtful small white spots in left upper zone. Sometimes in women it can also appear that way if hair is not tied above neck or any synthetic clothing is worn while taking X ray. Please be sure about this fact if you need to repeat your X ray again. Sometimes it can be due to patient positioning also or due to any variation in normal anatomical structures. Talking about your aviation career, I do not see any significant risk to you or anyone else around even if we take for granted that these are indeed healed granulomas. The blood tests for TB are normal and are reliable. The ESR is not a very specific test and might not hold much of significance in many people. I would suggest you the following if further evaluation becomes necessary keeping in mind your fitness for employment. (i) Get another chest X ray done in a different diagnostic centre and request a digital image on a CD/ DVD. (ii) If the doubtful white dots are still present on repeat X ray, after consulting a chest specialist, you may get a CT scan chest done to confirm the location and appearance of the spots and if they are inside the lung or on surface. This is usually confirmatory and will remove any kind of doubt on its existence. Hope your query is answered. DO write back if you have any doubts. Regards, Dr.Vivek

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Brief Answer: Please find detailed answer below Detailed Answer: Hi XXXXX, Good evening and you are most welcome. Thanks for your feedback and queries. Being in India, any calcification noted in the lungs must be investigated for TB and then should it be investigated for any other disease. Similarly in the US such findings must be investigated for diseases of autoimmune origin like sarcoidosis. Though it can occur in any pattern, TB does have an affinity for the upper zones of lungs and that is why your doctor has asked you for complete investigation reports. If it is only calcific nodules then its unlikely to be active TB. It is said that if two chest X rays taken 6 months apart show no change in findings then the disease is stable and not active. CT scan will show any associated changes in lung which might be missed on chest X ray. The lungs are covered on the surface by two thin layers of membranes called pleura. Calcifications are known to occur on the pleura also. Thats what I meant in saying that the spots can be on the surface of lungs. Biopsy or FNAC of lung spots is usually done by placing the patient in a CT scan machine and then taking out sample from the suspected spot using a long needle. I myself have done many lung biopsies and FNACs while working in a leading cancer hospital at Bangalore. For a biopsy to be done the spot should be at least 10 mm in diameter and should contain soft tissue component which may contain cells. Just calcified nodules which are very small cannot be biopsied and need follow up imaging after few months and keeping in mind patient symptoms, which means that biopsy is not possible in every patient with calcifications. A biopsy will tell us the nature of cells in the area and if its typical for TB. Active or latent TB is more of a clinical diagnosis. Please remember that TB can affect any part of the body from head to toe. It is more associated with chest TB because that is more commonly seen in any population. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

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