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What Causes Coughing And Wheezing In A Smoker?

Posted on Mon, 12 May 2014

Question: Age 58, smoker, family history lung cancer, possible exposure to asbestos, couch, wheeze, coughing up blood, ex heavy smoker 30yrs. x ray shows lung fields clear, pleural recesses normal but minor pleural tenting at the level of the left cardiac apex. Radiologist suggests this probably represents some residual changes from a previous inflammatory process and is therefore considered of no current significance. However no record of previous chest radiology in radiology clinic to confirm chronocity of this finding. Is this a sign of cancer? What is minor pleural tenting?

Answered by Dr. Shashi Dangwal (4 hours later)

Brief Answer: Minor pleural thickening may indicate some old inf Detailed Answer: Hello XXXXXXX , Thanks for posting your query on HCM. Your symptoms of cough and wheeze along with h/o smoking in the past suggest that you could be having COPD. What is the quantity and frequency of blood that you are bringing out? Blood in sputum could be a result of superadded infection. However it cannot be ignored. Your chest x ray seems to be normal and minor tenting of diaphragm could be a residual effect of some old inflammation. It does not indicate lung cancer. In view of haemoptysis(blood in sputum), I suggest you get a CT scan of the chest done which can highlight any lesion that is not seen on chest xray. You may also get your sputum examined for malignant cells.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Shashi Dangwal (12 hours later)

Hi, I am not sure what you mean, you refer to my statement 'minor pleural tenting' as 'minor pleural thickening' and both 'minor tenting of the diaphragm'. Why hasn't the radiologist used these words to describe 'minor pleural tenting'. Is pleural thickening a possible symptom of asbestos exposure? What is tenting of the diaphragm indicative of? XXXXXXX

Answered by Dr. Shashi Dangwal (34 hours later)

Brief Answer: Pleural tenting is a result of pleural thickening. Detailed Answer: The pleural tenting mentioned by you appears to be a result of minor pleural thickening which usually occurs because of some inflammation. In your case it is at the level of left cardiac apex which is also the level of left cupola of diaphragm. The pleural thickening may cause a pull on the diaphragm which may appear tented on chest xray. It seems this is what is happening in your case. Pleural thickening may be a sign of asbestos exposure but in your case it appears to be highly unlikely. I hope I have been able to clarify your doubts. In case you have any more query, do post them on HCM and will try and answer them. Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar