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Dr. Andrew Rynne

Family Physician

Exp 50 years

I will be looking into your question and guiding you through the process. Please write your question below.

Hello, After my PCP visit I m trying to assess

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Dr. Jnikolla

Pulmonologist

Practicing since :2003

Answered : 1526 Questions

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Posted on Thu, 20 Dec 2018 in Lung and Chest disorders
Question: Hello,
After my PCP visit I'm trying to assess my approximate probability of pulmonary fibrosis or something more serious than infection. I live in the midwest(USA) where there are alot of histoplasmosis and I mow and rake leaves in my yard(wooded) where there are lots of birds.I just finished reading about pulmonary fibrosis and the relationship to fungal exposure which I thinh has been ongoing for about 20 years. Can you estimate the probability of PF or any other serious diseases based on my ct? I'm trying to get a % if possible. I'm otherwise healthy, quit smoking 33 years ago(after 34 pack years) and am physically very active on a daily basis Had a normal cbc and complete blood count 7 weeks ago. Thanks for your expertise and time. A rough percentage would be very nice. XXXXXXX XXXXXXX
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Follow up: Dr. Jnikolla 0 minute later
Hello,
After my PCP visit I'm trying to assess my approximate probability of pulmonary fibrosis or something more serious than infection. I live in the midwest(USA) where there are alot of histoplasmosis and I mow and rake leaves in my yard(wooded) where there are lots of birds.I just finished reading about pulmonary fibrosis and the relationship to fungal exposure which I thinh has been ongoing for about 20 years. Can you estimate the probability of PF or any other serious diseases based on my ct? I'm trying to get a % if possible. I'm otherwise healthy, quit smoking 33 years ago(after 34 pack years) and am physically very active on a daily basis Had a normal cbc and complete blood count 7 weeks ago. Thanks for your expertise and time. A rough percentage would be very nice. XXXXXXX XXXXXXX
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Follow up: Dr. Jnikolla 1 minute later
I failed to mention that this is a follow-up to a question including my ct results sent recently.
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Follow up: Dr. Jnikolla 0 minute later
I failed to mention that this is a follow-up to a question including my ct results sent recently.
doctor
Answered by Dr. Jnikolla 59 minutes later
Brief Answer:
please attach ct images

Detailed Answer:
Hello

Its Dr Jolanda responding again

First, I would like to explain to you that there are several types of pulmonary fibrosis. The most common is post inflammatory pulmonary fibrosis which is the easiest one. The characteristic of pulmonary fibrosis of nearly every type is that it is extended in all the lung tissue.

You chest CT result explain that there is a local atelectasis probably post inflammatory one which doesn't mean that you already have PF or that you will definitely have PF.

We don't use percentage but we follow up continuously the patients who have signs and symptoms suspicious of PF in early stages in smokers or ex-smokers, such as a chronic dry cough with or without breathlessness in exertion.

Fungus exposure is not known as a direct causing factor of PF in the literature in my knowledge.
Nevertheless, it would be better for me to review the chest CT images attached first. Please upload/attach them here.

Hope to have been helpful and feel free to ask me again.

Regards

Dr.Jolanda


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
doctor
Answered by Dr. Jnikolla 0 minute later
Brief Answer:
please attach ct images

Detailed Answer:
Hello

Its Dr Jolanda responding again

First, I would like to explain to you that there are several types of pulmonary fibrosis. The most common is post inflammatory pulmonary fibrosis which is the easiest one. The characteristic of pulmonary fibrosis of nearly every type is that it is extended in all the lung tissue.

You chest CT result explain that there is a local atelectasis probably post inflammatory one which doesn't mean that you already have PF or that you will definitely have PF.

We don't use percentage but we follow up continuously the patients who have signs and symptoms suspicious of PF in early stages in smokers or ex-smokers, such as a chronic dry cough with or without breathlessness in exertion.

Fungus exposure is not known as a direct causing factor of PF in the literature in my knowledge.
Nevertheless, it would be better for me to review the chest CT images attached first. Please upload/attach them here.

Hope to have been helpful and feel free to ask me again.

Regards

Dr.Jolanda


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Jnikolla 1 hour later
Thank you - I have a CD Disk with my test results which the system will not let me upload. I took about 50 screenshots and uploaded them if that is helpful. If you need the full set of images to accurately make a diagnosis I would be happy to upload the rest of the images or if you know of a better way to get the images to you that would be great.
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Follow up: Dr. Jnikolla 0 minute later
Thank you - I have a CD Disk with my test results which the system will not let me upload. I took about 50 screenshots and uploaded them if that is helpful. If you need the full set of images to accurately make a diagnosis I would be happy to upload the rest of the images or if you know of a better way to get the images to you that would be great.
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Follow up: Dr. Jnikolla 49 minutes later
Also please see the report below with commentary from radiologist

Impression
New bilateral pulmonary nodules measuring up to 4 mm as detailed above.
Scattered areas of tree-in-bud nodularity are also new in interval. The
findings may reflect inflammatory changes. These nodules are
categorized as lung RADS category 3, probably benign. Six-month
follow-up low-dose chest CT is recommended for further surveillance.


ACR Lung-RADS Category/Recommendations:
0: Need prior comparisons or additional images
1: Negative: 12 month follow up LDCT (Low Dose CT)
2: Benign Appearing: 12 month follow up LDCT
3: Probably Benign: 6 month follow up LDCT
4A: Suspicious: 3 month follow up LDCT (or immediate PET if >7mm solid
component)
4B: Suspicious: Immediate Chest CT or PET if >7mm solid component
4X: Cat 3 or 4A nodules with additional suspicious findings
Modifier-"S": Significant NON-lung cancer findings
Modifier-"C": Prior treated Lung Cancer.

For details of the ACR Lung-RADS program, categories and
recommendations:
1) https://www.acr.org/Quality-Safety/Resources/LungRADS
2) Internet search: "Lung-RADS Lung Cancer Screening"
3) Contact SSM thoracic nurse coordinator (636-639-8640)
______________________



Reading Radiologist: Chadwick, Nicholson MD on 11/16/2018 at 10:53 AM

Narrative
CT chest without contrast

HISTORY: Former smoker. Follow-up pulmonary nodules

COMPARISON: CT chest favors 7 2018, CT chest XXXXXXX 8, 2017

Technique: Axial images were acquired through the chest without
contrast. Multiplanar reconstructions were reviewed.

FINDINGS:
The soft tissues the visualized lower neck and chest wall are
unremarkable. The thyroid enhances homogeneously. There is no
mediastinal or axillary lymphadenopathy by CT size criteria. Technique
limits evaluation for hilar lymph nodes. The heart is normal in size.
There is no significant pericardial fluid collection. The esophagus is
unremarkable. The caliber of the ascending thoracic aorta and main
pulmonary artery are normal. Scattered atherosclerotic vascular
calcifications are identified.

The major airways are patent. There is no focal consolidation, pleural
effusion, or pneumothorax. Linear atelectasis is identified in the
medial segment of the left lower lobe. Biapical pleural scarring is
noted. New nodularity in the anterior aspects of the left lower lobe is
noted measuring 2 mm. This may represent a small vessel. Oblong 4 mm
nodule in the lateral aspect of the right lower lobe is unchanged,
series 3 image 218. 2 mm nodules in the right lower lobe were not
previously seen, series 3 image 228, 286, 293. A new 4 mm nodule is
identified in the lateral aspect of the left upper lobe, series 3 image
166. Subtle tree-in-bud and groundglass nodularity is identified in the
medial aspect of the left upper lobe, series 3 image 11 for example.
This is more apparent versus the comparison study. Additional new
nodules in the mid aspect of the left lower lobe and tree-in-bud
nodularity is noted, series 3 image 269-277. These nodules measure 2-3
mm. New 3 mm nodule identified in the left lower lobe, series 3 image
225.

Limited view of the subdiaphragmatic structures demonstrates no acute
findings.

Nonacute appearing left-sided rib fractures noted. No destructive
osseous lesions are identified. Vertebral body heights are maintained.
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Follow up: Dr. Jnikolla 0 minute later
Also please see the report below with commentary from radiologist

Impression
New bilateral pulmonary nodules measuring up to 4 mm as detailed above.
Scattered areas of tree-in-bud nodularity are also new in interval. The
findings may reflect inflammatory changes. These nodules are
categorized as lung RADS category 3, probably benign. Six-month
follow-up low-dose chest CT is recommended for further surveillance.


ACR Lung-RADS Category/Recommendations:
0: Need prior comparisons or additional images
1: Negative: 12 month follow up LDCT (Low Dose CT)
2: Benign Appearing: 12 month follow up LDCT
3: Probably Benign: 6 month follow up LDCT
4A: Suspicious: 3 month follow up LDCT (or immediate PET if >7mm solid
component)
4B: Suspicious: Immediate Chest CT or PET if >7mm solid component
4X: Cat 3 or 4A nodules with additional suspicious findings
Modifier-"S": Significant NON-lung cancer findings
Modifier-"C": Prior treated Lung Cancer.

For details of the ACR Lung-RADS program, categories and
recommendations:
1) https://www.acr.org/Quality-Safety/Resources/LungRADS
2) Internet search: "Lung-RADS Lung Cancer Screening"
3) Contact SSM thoracic nurse coordinator (636-639-8640)
______________________



Reading Radiologist: Chadwick, Nicholson MD on 11/16/2018 at 10:53 AM

Narrative
CT chest without contrast

HISTORY: Former smoker. Follow-up pulmonary nodules

COMPARISON: CT chest favors 7 2018, CT chest XXXXXXX 8, 2017

Technique: Axial images were acquired through the chest without
contrast. Multiplanar reconstructions were reviewed.

FINDINGS:
The soft tissues the visualized lower neck and chest wall are
unremarkable. The thyroid enhances homogeneously. There is no
mediastinal or axillary lymphadenopathy by CT size criteria. Technique
limits evaluation for hilar lymph nodes. The heart is normal in size.
There is no significant pericardial fluid collection. The esophagus is
unremarkable. The caliber of the ascending thoracic aorta and main
pulmonary artery are normal. Scattered atherosclerotic vascular
calcifications are identified.

The major airways are patent. There is no focal consolidation, pleural
effusion, or pneumothorax. Linear atelectasis is identified in the
medial segment of the left lower lobe. Biapical pleural scarring is
noted. New nodularity in the anterior aspects of the left lower lobe is
noted measuring 2 mm. This may represent a small vessel. Oblong 4 mm
nodule in the lateral aspect of the right lower lobe is unchanged,
series 3 image 218. 2 mm nodules in the right lower lobe were not
previously seen, series 3 image 228, 286, 293. A new 4 mm nodule is
identified in the lateral aspect of the left upper lobe, series 3 image
166. Subtle tree-in-bud and groundglass nodularity is identified in the
medial aspect of the left upper lobe, series 3 image 11 for example.
This is more apparent versus the comparison study. Additional new
nodules in the mid aspect of the left lower lobe and tree-in-bud
nodularity is noted, series 3 image 269-277. These nodules measure 2-3
mm. New 3 mm nodule identified in the left lower lobe, series 3 image
225.

Limited view of the subdiaphragmatic structures demonstrates no acute
findings.

Nonacute appearing left-sided rib fractures noted. No destructive
osseous lesions are identified. Vertebral body heights are maintained.
doctor
Answered by Dr. Jnikolla 6 hours later
Brief Answer:
continue discussion

Detailed Answer:
Hi again

I saw the images.Please attach the images like that of number 10 (lung window ) the lung tissue. It is very important to detect PF.
However according to the result the main issues are lung nodules not PF prescribed.

Regards

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
doctor
Answered by Dr. Jnikolla 0 minute later
Brief Answer:
continue discussion

Detailed Answer:
Hi again

I saw the images.Please attach the images like that of number 10 (lung window ) the lung tissue. It is very important to detect PF.
However according to the result the main issues are lung nodules not PF prescribed.

Regards

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Jnikolla 8 hours later
Are you saying that if PF was a concern, it would have been noted in the written report?
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Follow up: Dr. Jnikolla 0 minute later
Are you saying that if PF was a concern, it would have been noted in the written report?
doctor
Answered by Dr. Jnikolla 10 minutes later
Brief Answer:
continue discussion

Detailed Answer:
Hi again

I saw again carefully the images and i don't think PF is evident. In the report is not specified that PF is likely. The main problem are the follow up of the nodules not the presence of PF.
I hope to have been helpful

Regards

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Jnikolla 0 minute later
Brief Answer:
continue discussion

Detailed Answer:
Hi again

I saw again carefully the images and i don't think PF is evident. In the report is not specified that PF is likely. The main problem are the follow up of the nodules not the presence of PF.
I hope to have been helpful

Regards

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Jnikolla 57 minutes later
Thank you so much for your timely answer!
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Follow up: Dr. Jnikolla 0 minute later
Thank you so much for your timely answer!
doctor
Answered by Dr. Jnikolla 1 hour later
Brief Answer:
welcome

Detailed Answer:
You are welcome anytime

Best wishes

Dr.JJolanda
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Jnikolla 0 minute later
Brief Answer:
welcome

Detailed Answer:
You are welcome anytime

Best wishes

Dr.JJolanda
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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