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What Do These X-ray Findings Indicate?
Question: My brother had x-rays done yesterday and today he read the results on line. There are further tests planned, but can you tell me what your general impression is of the following report?
"CHEST PA AND LATERAL VIEWS PREFER
IMPRESSION:
Interstitial fibrosis. Right infrahilar mass. Correlation with CT is suggested.
END OF IMPRESSION:
INDICATION: Cough and wheezing
TECHNIQUE: PA and lateral projections of the chest are acquired.
COMPARISON: 1/8/2013 and 12/29/2012
FINDINGS:
The heart size is normal. The vascular distribution is normal. The hilar and mediastinal silhouettes appear unremarkable. The lungs are underinflated, there is diffuse prominence of interstitial markings. Taking into account slight differences in technique this is unchanged. There is suggestion of a right infrahilar mass measuring approximately 3.8 x 5 cm. No pleural effusion is identified. There is no evidence of pneumothorax. There are no significant bony findings.
He was a heavy smoker for years and only quit 2 years ago at age 60. His doctor wants to do a CT scan but wants to make sure his kidneys can handle the chemical injected (for contrast?). Apparently his blood work not long ago showed some renal issues. Previous treatment for cough and fatigue was prescription medications that initially helped some but relief did not last. I'm very concerned because my father had pleural effusion when he was diagnosed with inoperable squamus cell carcinoma (I think) of the lungs 28 years ago, also age 62, and also a heavy smoker. The surgeon at the time said it was slow growing and might have been treatable had it been found several years earlier.
"CHEST PA AND LATERAL VIEWS PREFER
IMPRESSION:
Interstitial fibrosis. Right infrahilar mass. Correlation with CT is suggested.
END OF IMPRESSION:
INDICATION: Cough and wheezing
TECHNIQUE: PA and lateral projections of the chest are acquired.
COMPARISON: 1/8/2013 and 12/29/2012
FINDINGS:
The heart size is normal. The vascular distribution is normal. The hilar and mediastinal silhouettes appear unremarkable. The lungs are underinflated, there is diffuse prominence of interstitial markings. Taking into account slight differences in technique this is unchanged. There is suggestion of a right infrahilar mass measuring approximately 3.8 x 5 cm. No pleural effusion is identified. There is no evidence of pneumothorax. There are no significant bony findings.
He was a heavy smoker for years and only quit 2 years ago at age 60. His doctor wants to do a CT scan but wants to make sure his kidneys can handle the chemical injected (for contrast?). Apparently his blood work not long ago showed some renal issues. Previous treatment for cough and fatigue was prescription medications that initially helped some but relief did not last. I'm very concerned because my father had pleural effusion when he was diagnosed with inoperable squamus cell carcinoma (I think) of the lungs 28 years ago, also age 62, and also a heavy smoker. The surgeon at the time said it was slow growing and might have been treatable had it been found several years earlier.
Brief Answer:
It is important to do a CT guided lung biopsy immediately
Detailed Answer:
Hi XXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. There is a concern about a suspected cancer in the right lung. The hilum is an area where the lung is attached to the main bronchus or large airway. A 3.8 x 5 cm mass is to be evaluated in detail and complete evaluation is required to make a confirmed diagnosis.
2. Other than the above suspected mass, there are fibrotic changes in the lungs which might be related with long history of smoking.
3. There is no mention of the mass being visible in chest X ray done on 01-08-2013 and 12-09-2012. I guess that this might be a recent development.
4. A CT scan is important to proceed with further evaluation. If there is a problem with his kidneys then a plain CT might be planned and a biopsy from the lung mass can also be done in the same session. I have done many of these biopsies in patients with suspected lung mass.
5. You might also take a nephrology consultation and discuss if the N-acetylcysteine renal protection protocol might be implemented and then a CT scan thorax (plain and contrast) can be decided upon.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
It is important to do a CT guided lung biopsy immediately
Detailed Answer:
Hi XXXXX,
Thanks for writing in to us.
I have read through your query in detail.
Please find my observations below.
1. There is a concern about a suspected cancer in the right lung. The hilum is an area where the lung is attached to the main bronchus or large airway. A 3.8 x 5 cm mass is to be evaluated in detail and complete evaluation is required to make a confirmed diagnosis.
2. Other than the above suspected mass, there are fibrotic changes in the lungs which might be related with long history of smoking.
3. There is no mention of the mass being visible in chest X ray done on 01-08-2013 and 12-09-2012. I guess that this might be a recent development.
4. A CT scan is important to proceed with further evaluation. If there is a problem with his kidneys then a plain CT might be planned and a biopsy from the lung mass can also be done in the same session. I have done many of these biopsies in patients with suspected lung mass.
5. You might also take a nephrology consultation and discuss if the N-acetylcysteine renal protection protocol might be implemented and then a CT scan thorax (plain and contrast) can be decided upon.
Hope this answers your question. Please feel free to correct any oversight in my interpretation of your problems and discuss them in detail as per your requirements.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Today my brother had the blood tests that showed it was borderline whether he should have the contrast with the CT scan. His Dr. decided to proceed with the contrast. The results show a mass in his lower right lung and also a larger mass in his upper chest below the thyroid outside of the lung. He has an appointment with a cardio-thoracic surgeon to do biopsies in a week. His Dr. also said the specialist may do a PET scan.
My questions:
How difficult is it, and what proceedure is used, to get a biopsy from the lower lung area, will it be painful afterwards and will he need someone to care for him afterwards?
My questions:
How difficult is it, and what proceedure is used, to get a biopsy from the lower lung area, will it be painful afterwards and will he need someone to care for him afterwards?
Brief Answer:
He can go home right after biopsy procedure
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
1. In cases of suspected cancer, it is essential to do a contrast CT scan to know the extent and nature of disease accurately. PET scan is to know if there is any hidden cancer spreda elsewhere like brain and bones.
2. The next step involves doing a FNAC (fine needle aspiration cytology) or a biopsy. The FNAC is a milder form of biopsy sampling in which a long needle is inserted in the disease area and few cells are sucked into a syringe and later smeared on to a glass slide which is looked at under the microscpoe. This is a 2 minute procedure and done under CT scan guidance. It is painful like an injection prick.
3. In biopsy, local anesthesia is injected in the skin around the pricking site and a small XXXXXXX is made with a blade. Then a bigger cutting needile is inserted and a small amount of tissue is sampled in the disease area. The samples tissue is then put in a formalin bottle and sent to the pathologist. The tissue sample is more than the above procedure and the diagnosis is confirmed. Pain is like a bee sting.
4. There are slight risk of lung collapse by above procedures but with care these might be minimzed. We do a CT scan after FNAC or biopsy to make certain that there has been no complication like lung collapse.
5. After the procedure he should not cough or talk too much for 6 hours. He can go home right after the procedure if his pulse and bloodpressure are normal for 15 minutes following the procedure.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
He can go home right after biopsy procedure
Detailed Answer:
Hi XXXXX,
Thanks for writing back with an update.
1. In cases of suspected cancer, it is essential to do a contrast CT scan to know the extent and nature of disease accurately. PET scan is to know if there is any hidden cancer spreda elsewhere like brain and bones.
2. The next step involves doing a FNAC (fine needle aspiration cytology) or a biopsy. The FNAC is a milder form of biopsy sampling in which a long needle is inserted in the disease area and few cells are sucked into a syringe and later smeared on to a glass slide which is looked at under the microscpoe. This is a 2 minute procedure and done under CT scan guidance. It is painful like an injection prick.
3. In biopsy, local anesthesia is injected in the skin around the pricking site and a small XXXXXXX is made with a blade. Then a bigger cutting needile is inserted and a small amount of tissue is sampled in the disease area. The samples tissue is then put in a formalin bottle and sent to the pathologist. The tissue sample is more than the above procedure and the diagnosis is confirmed. Pain is like a bee sting.
4. There are slight risk of lung collapse by above procedures but with care these might be minimzed. We do a CT scan after FNAC or biopsy to make certain that there has been no complication like lung collapse.
5. After the procedure he should not cough or talk too much for 6 hours. He can go home right after the procedure if his pulse and bloodpressure are normal for 15 minutes following the procedure.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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