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Chest x-ray report show bilateral pulmonary hyperaeration and apical pleural thickening. Meaning?

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Had a recent medical examination including chest x-ray. The medical imaging report indicated the following impressions:
bilateral pulmonary hyperaeration
apical pleural thickening
bilateral atheromatous aorta
what do these mean?

Finding from the ECG test indicated "Poor R Wave Progression". Does this indicate any heart condition?
Posted Mon, 10 Jun 2013 in X-ray, Lab tests and Scans
Answered by Dr. Nirmala P 3 hours later
Thanks for asking in Healthcare Magic.

Bilateral pulmonary hypertension indicates increased pulmonary arterial pressure and pulmonary vascular resistance. This means, the hemodynamics of pulmonary system is altered.

Apical pleural thickening indicates to curved density at lung apex(top). Occurs due to previous lung infection like TB or inflammation. Pleura is a thin bi layer covering the apical portion of lung.

Bilateral atheroma means the atherosclerotic lesion of aorta. Risk factor is high if it is more than 4mm thickness. All these findings indicate that you are having hypertension (increased BP) that needs treatment.

Poor R wave progression indicates the transition in voltage in the precordial leads of an ECG. It is a vague term, often inconclusive especially in women and is not a diagnosis. When the peak voltage occurs later than v4 it is considered as delayed because in normal persons, there is increased progression in the magnitude of voltage from v1 to v4.

I hope this helps. Please address to me if you have any further concerns.
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Follow-up: Chest x-ray report show bilateral pulmonary hyperaeration and apical pleural thickening. Meaning? 1 hour later
Would you suggest i see a pulmonary expert or a cardiologist or both? Does having bilateral atheroma mean having a heart condition? My blood pressure has been steady at 90/60 or at most 100/70. What are the symptoms of a bilateral atheroma that i should be on the look out for? Any medication needed for apical pleural thickening?

Thank you.
Answered by Dr. Nirmala P 1 hour later
Welcome back to Healthcare Magic.

Atheroma formation or atherogenesis occurs over a period of many years. Increased cholesterol results in accumulation of LDL on the intima (inner layer) of the artery. These lipoproteins undergo changes and stimulate inflammatory changes in the artery and causes leukocytes (white cells) attachment. Once getting attached the white cells migrate in to intima and enhances monocyte and phagoctytes attahment along with platelets form the atheroma.

Initially, the artery remodels and the elasticity of the artery helps in bulging out to accomadate the atheroma without causing lumen occlusion. Although coronary artery is the frequent site for atheroma formation, it can occur at other sites too. Risk factors for atheroma formation are atherogenic (fatty) diet,obesity, physical inactivity or menopause. Although it is a risk factor for CAD (coronary artery disease), myocardial infarction, embolism and stroke, you need not worry as many hypolipedemic drugs, anti platelets and thrombolytics are available for treatment and these are very effective.

The most common symptom in pulmonary hypertension is exertional dyspnoea (air hunger on exertion). Other symptoms are fatigue, swelling of feet (this occurs much later) and dizziness. Drugs like Bosentan are available for the treatment of Pulmonary hypertension.

You should also rule out Diabetes and hypercholestrolemia (increase in cholesterol). No medication is available for pleural thickening. If there is breathlessness, then drugs like steroids or bronchodilators are given as symptomatic treatment. Thoracocentesis is done to alleviate the pressure if there is fluid accumulation in pleura.

You should consult a cardiologist who will be able to guide you for further follow up.
I hope I have answered your queries.
Warm Regards.
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