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Dr. Andrew Rynne

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What do the following CT test results indicate?

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Dr. Indu Kumar

Radiologist

Practicing since :2004

Answered : 6728 Questions

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Posted on Sat, 18 Mar 2017 in X-ray, Lab tests and Scans
Question: Hello,

I would like to consult with a Radiologist to review some CT images, if possible. I am concerned about lung malignancy. Mainly Bronchoalveolar Carcinoma worries me.

Below I have listed the relevant studies with Online Viewing links. Please let me know if I can get a reading and evaluation of these scans.

Thank you!

Relevant Symptom History: Shortness of breath, Coughing, Nail Clubbing for 3.5 months
Note: Everything to the right of the ">" symbol should be click-able as a URL Link

>>(12/22/16) CT Chest With Contrast (PE contrast XXXXXXX protocol) -- http://www.dicomlibrary.com/?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000

If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaeXAyWFZ4M2hGeEE


>>(12/02/16) Noncontrast CT Chest (Helical, with HRCT reformats also taken) -- http://www.dicomlibrary.com/meddream/index.php?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000

If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaR19FRUx2R2hJMkk

=======

1) The original radiologist had seen a geographic ground glass opacity on the Chest CT w/ Contrast. Can you please tell me if that GGO looks malignant? I am wondering about the following likely malignant characteristics...
--How large would you estimate it? Say 10 mm, 2 cm, etc.?
--Are the margins clear-cut or ill-defined?
--As for shape, is it nonpolygonal or is it polygonal?
--Is there any apparent radial growth?
--Is there any spiculation on the border?
--Is "bubble lucency" present?

2) Why was that Ground glass opacity (or any other abnormality) not seen on the Noncontrast Chest CT?
Both studies were done at roughly the same scan parameters, in supine position...only difference was use of contrast XXXXXXX
doctor
Answered by Dr. Indu Kumar 3 hours later
Brief Answer:
There is a small ground glass opacity in left basal area of lung.

Detailed Answer:
Hello,
Thanks for writing to HealthcareMagic,
I've gone through your query and understand your concern,

I have gone through all the images and report.
There is a small ground glass opacity in left basal area of lung.

It is approx 1.0 cm in diameter and margins are hazy. There are no spiculation , bubble lucency etc and there are no signs of malignancy.

It is generally not a significant finding and well seen only in one section,this may be the reason for omission in one report.

Ground glass opacity may be due to many reasons like past infection etc.
It is generally not concerning.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Indu Kumar 17 minutes later
Thank you doctor.

1) Can you point out on the image where the ground glass opacity is?
2) Why is it not visible on Noncontrast CT (done at High Resolution, helical)?

3) Would you characterize the ground glass opacity interface as:
a) ill-defined
b) well-defined and smooth
c) well-defined but coarse = (which I have heard is most likely for malignancy)

4) Is bronchoalveolar carcinoma possible with this presentation?
doctor
Answered by Dr. Indu Kumar 1 hour later
Brief Answer:
Findings doesn't support carcinoma.

Detailed Answer:
Hello,
Thanks for writing to HealthcareMagic,
I've gone through your query and understand your concern,

It is in left lung(lower part).
Ideally it is well evaluated in HRCT(lung window).It may be missed in other settings.

It is ill defined with hazy margins.
Findings doesn't support carcinoma.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Indu Kumar 17 minutes later
Hi doctor,

Thanks for your explanation

1) Which section/image in the series can I look at to find this ground glass opacity?

2) The HRCT (lung window) Noncontrast done on Dec. 02, 2016 did not seem to show the Ground glass finding or any other abnormality at all.

The pulmonologist said that if the ground glass was seen on Contrast exam, he would order Noncontrast HRCT to re-evaluate the area.

So if I am not wrong, the Noncontrast Dec. 02, 2016 exam is considered the superior test for ground glass evaluation as opposed to the Contrast exam, right?

3) Also, I had done the HRCT Noncontrast as Inspiratory scan whereas the Contrast exam was done on a machine that did not require inhalation. Does this cause any differences?

4) Is there any kind of follow-up study that can be done?
doctor
Answered by Dr. Indu Kumar 19 minutes later
Brief Answer:
You are right,HRCT is the ideal investigation.

Detailed Answer:
Hello,
Thanks for writing to HealthcareMagic,
I've gone through your query and understand your concern,

You may go through series 7.

You are right,HRCT is the ideal investigation.
Contrast CT scan may misinterpret the findings.

I don't think it is a serious finding.It may be due to recent infection.

You may need follow up after six months.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Indu Kumar 17 minutes later
Thank you doctor.

Just a few more doubts...

--Would you say that the Noncontrast HRCT (Dec. 02, 2016) I have attached has adequately studied the lungs?

--What slice number in series 7 should I be looking at?
doctor
Answered by Dr. Indu Kumar 7 hours later
Brief Answer:
It is present in contrast images(series 7,prominent in image 74-78).

Detailed Answer:
Hello,
Thanks for writing to HealthcareMagic,
I've gone through your query and understand your concern,

I am not fully open the non contrast images due to technical difficulty but it is present in contrast images(series 7,prominent in image 74-78).

Don't worry at all.It is not not very significant.You may need follow up scanning.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Indu Kumar 9 hours later
Hi doctor,

I have attached "Noncontrast-Lung-Window-Images.pdf" file which has visualized portion of lung bases on the Noncontrast Scan.

--Does it look technically adequate?

-Please review, compare to contrast, and let me know your feedback.

Thank you!
doctor
Answered by Dr. Indu Kumar 16 hours later
Brief Answer:
Non contrast images appears normal.

Detailed Answer:
Hello,
Thanks for writing to HealthcareMagic,
I've gone through your query and understand your concern,

I have gone through all the uploaded images.
Non contrast images appears normal.There are no lesions seen.

Get well soon.

Hope I have answered your query.
Further queries are most welcome.

Take Care
Dr. Indu XXXXXXX
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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