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How Could A Recent CT Scan Show No Signs Of Bronchietasis Which Was Previously Present?

Posted on Mon, 11 Jul 2022

Question: I just received the results of my CT which was a follow up to the CT I did last year. Lady year’s (without contrast) showed mild bronchiectasis. Yesterday’s CT (with contrast) showed no bronchiectasis. How is that possible? It was done by the same lab but read by a different radiologist. Could it have just been missed? I find that hard to believe since it was done with contrast. Does that mean I do not have bronchiectasis? I have had almost no shortness of breath episodes in a few weeks.

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
This is actually not possible.

Detailed Answer:

Hi,

Yes, you are right. This is actually not possible. Bronchiectesis is structural change in lung tissue which is permanent. So it is not possible to have no bronchiectesis on recent CT when you had it on your previous CT.

Honestly speaking, this is mostly due to subjective variation in CT reporting. New radiologist might have missed it. Routinely there is no need for contrast for bronchiectesis. We pulmonologist prefer HRCT (high resolution CT) thorax without contrast for follow up in bronchiectesis.

Please let me know
1. Was the first CT a HRCT or plain CT?
2. What was the indication for contrast in this CT?

Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Drkaushal85 (8 hours later)

The first CT was plain. For the second CT, here is the story. I changed Pulms mid year. My new pulm is more aggressive, and he prefers contrast. Should I go back to them and say this impossible, could it be looked at again?

Answered by Dr. Drkaushal85 (4 minutes later)

Brief Answer:
Yes, you should definitely demand for second look.

Detailed Answer:

Hi,

Yes, you should definitely demand for second look.
Or you can send your previous CT films and ask them to compare both the films (recent one and previous one).

Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.

Above answer was peer-reviewed by : Dr. Kampana

Follow up: Dr. Drkaushal85 (36 minutes later)

The CT from this week indicates-"Tracheobronchial Tree-appears unremarkable". The CT from 11 months ago says "Bronchi: The visualized airways are patent. There is mild bilateral bronchiectasis." Is the tracheobronchial tree the same as the bronchi?

Answered by Dr. Drkaushal85 (20 minutes later)

Brief Answer:
Can you send me images of previous CT?

Detailed Answer:

Hi,

Yes, both are same. This is insane. You had bilateral mild bronchiectesis. And now normal CT thorax without bronchiectesis. This is weird.

Can you send me picture of your previous CT films?
I think there might be some error.

I will be happy to help you further. Wish you good health. Thanks.

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

Follow up: Dr. Drkaushal85 (2 hours later)

I have CD's comparing the two CTs, but how do I get them to you? Mail? Anyway, I went back to the radiology company and they will have the radiologist speak to my pulm.

Answered by Dr. Drkaushal85 (35 minutes later)

Brief Answer:
You can send me via attachment.

Detailed Answer:

Hi,

There is an 'attachment' / 'reports' section in your query. You can directly upload/attach them there during your follow-up question.
You can also send me any report or image via e-mail. You can ask customer care team for assistance.

And yes it is a good idea to get communication between Radiologist and Pulmonologist.
Also, ask for the comparison with previous CT if possible.

I will be happy to help you further. Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Drkaushal85 (51 minutes later)

Ok, I think this will answer a few things. I spoke to the radiologist. He said I do not have bronchiectasis. Is this a miracle? Well, no. He looked at last year's CT and would not have classified that finding as bronchiectasis. He understands what the other radiologist was seeing, but it so slight, and technically, it was not BX. So I asked why are my fingers clubbed and he said it might be genetic. i did not ask him why was I coughing up gobs of mucus? (I haven't in weeks and no SOB bouts in weeks) I will ask my pulm on Monday. So it looks like this has a happy ending

Answered by Dr. Drkaushal85 (40 minutes later)

Brief Answer:
Yes, it is good that you are not having bronchiectasis.

Detailed Answer:

Hi,

This is excellent. See I was telling you about subjective variation in radiologist's reporting. Well, in the end, it is good that he told you don't have bronchiectasis.

In my opinion, there might be some chance of having bronchitis. Have you ever undergone PFT (Pulmonary Function Test)?

Bronchitis can explain everything, cough, mucus, breathing difficulty, bilateral CT abnormality, reversibility of abnormal CT finding etc.

I will be happy to help you further. Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Drkaushal85 (37 minutes later)

That’s interesting you should bring that up. I was going to ask you , now that it’s not BX, what could be causing my SOB and spitting up mucus? I haven’t had an SOB occurrence in several weeks, and I only occasionally need the spit up mucus. You think it might be bronchitis? Would that be chronic bronchitis? Is there anything I can do about it?

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I have never touched a cigarette. My PFT was excellent, in fact one of the best results they have ever seen. I blew over 120 which 11% theoretical limit.

Answered by Dr. Drkaushal85 (1 hour later)

Brief Answer:
Have you ever undergone PFT

Detailed Answer:

Hi,

I need more information for confirming whether it was acute bronchitis or chronic bronchitis.
Please let me know:
1. Do you smoke?
2. Have you ever undergone PFT (Pulmonary Function Test)? If yes, how long back and how were the results...

Please let me know the answers of above-asked questions so that I can guide you better.
I will be happy to help you further.

Wish you good health.
Thanks.

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Brief Answer:
need to rule out bronchitis

Detailed Answer:

Hi,

It's great that you never touched a cigarette.
Glad to know your PFT values were also above par. So then, just go ahead with the Pulmonologist's visit and also discuss regarding the possibilities of bronchitis (chronic or not, can only be ascertained after a clinical check-up).

I will be happy to help you further. Wish you good health.
Thanks.

Above answer was peer-reviewed by : Dr. Arnab Banerjee