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How To Differentiate Between Bronchitis And Emphysematous?

Posted on Fri, 12 Oct 2018

Question: I was hoping to get a second opinion on an xray the radiologist that read the x-ray said it appears emphysematous however I am a 28 year old non smoker and the doctor that was treating me said she felt it was bronchitis.

Answered by Dr. Drkaushal85 (2 hours later)

Brief Answer:
I would rather say you have hyperinflated lungs.

Detailed Answer:
Hello,

I have gone through the X-ray film you have attached.
I would rather say that you have hyperinflated lungs.
Emphysematous lung fields is outdated terminology.
Now a days,'emphysema' term is not used.
Bronchitis is the right term.
And hyperinflated lungs are seen in bronchitis.

Other causes for hyper-inflated lungs are:
1. Long standing asthma
2. Lean, thin and tall buildup
3. If x ray is taken after deep inspiration and breath holding.
4. It can be inter-observor variation (some radiologist report this as normal while some report this as emphysematous or hyper-inflated lungs.

But the most important part for this is:
1. Symptoms of a patient.
2. Spectrometry report.

Hope I have answered your query.
Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (12 minutes later)

Thank you, I have yet to undergo a spirometry test but will bring it up with my primary care doctor hopefully early next week. My only symptom has been shortness of breath (which is sometimes worse in the morning) it almost feels like I just can't get a full breath so I inhale very deeply and then some right sided rib pain (which I think is quite possibly related to the deep breathing.) I would like to note that none of these symptoms were apparent until February 13th of this year...

Answered by Dr. Drkaushal85 (11 minutes later)

Brief Answer:
I need more information about your breathing difficulty.

Detailed Answer:
Hello,

1. Do you have breathlessness on exertion like climbing stairs, fast walking etc?
2. Do you have only difficulty in taking deep breath?

Hope I have answered your query.
Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (17 minutes later)

I don't notice it with exertion it seems more random. In all honesty it seems to be at it's worse when sitting. I am not having difficulty breathing deeply nor does it hurt I just feel the need to do it often.

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
I don't think it is bronchitis related breathing difficulty.

Detailed Answer:
Hello,

I don't think it is due to lung related (bronchitis).
Breathing difficulty due to bronchitis is seen with exertion and subside by rest.
So I don't think your symptoms are due to bronchitis.

Have observed fall in the oxygen saturation while having breathing difficulty?
Do you have allergies?

Hope I have answered your query.
Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (6 hours later)

Yes I do have an sp02 monitor and have noticed that at times when I feel I'm having trouble it will drop to about 88-93 but usually within the next reading or 2 it is back up to 96-100

Answered by Dr. Drkaushal85 (12 minutes later)

Brief Answer:
Are you taking any hormone pills?

Detailed Answer:
Hello,

This is interesting.
You have documented fall in oxygen saturation.
This is something we should definitely be evaluated.

Please let me know:
1. Are you taking any hormone pills?
2. Are you sexually active and taking any hormonal contraceptive pills?

I am asking this because I want to rule out pulmonary embolism (PE). You had a history of breast augmentation. So you might be taking any hormone, pills and these pills can cause PE.
It's absolutely fine if you don't want to answer these personal questions.

Hope I have answered your query.
Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Drkaushal85 (28 minutes later)

1. No I am not taking any type of hormonal pills 2. I am not on birth control, I am sexually active but my husband is military and is currently deployed so I am practicing abstinence. I have not been out of the country, nor do I notice any swelling or warm areas in either leg. In addition my eldest daughter has asthma and I know that my maternal uncle has it as well. I also have panic attacks but have tried taking my medication to see if that is the issue and still feel the need to deeply inhale even after that. Basic break down of how this all came to be feb 2nd I was seen at urgent care for a sore throat and post nasal drip they prescribed a decongestant and sent me on my way feb 13th I started feeling like i was really tired and couldn't catch my breath but wrote it off to being up with my children later than normal feb 14th I still felt as though I couldn't catch my breath and that's when I was seen again and had the xray that you reviwed. At this time they diagnosed me with bronchitis, gave me prednisone and albeuterol and advised to follow up with my primary care provider. They called me back on the 16th to tell me about the emphysematous comment. I have a minor cough on slight occasion, still some post nasal drip but nothing else. It is really just the difficulty breathing.

Answered by Dr. Drkaushal85 (4 hours later)

Brief Answer:
Possibility of PE is very very less.

Detailed Answer:
Hello,

Possibility of PE is very less.
Sometimes non-diagnosed stress and anxiety can also cause similar symptoms.
You had panic attacks.
So stress and anxiety are more likely in your case.

So please let me know:
1. Do you have stressful life?
2. Are you consulting psychiatrist for this?

Hope I have answered your query.
Let me know if I can assist you further.

Regards,
Dr. Kaushal Bhavsar,
Pulmonologist

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