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What does a normal CT scan showing low DLCO indicate?

Answered by
Dr.
Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14575 Questions

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Posted on Thu, 15 Sep 2016 in Lung and Chest disorders
Question: What conditions could cause an isolated reduced dlco but a normal ct?
doctor
Answered by Dr. Kaushal Bhavsar 7 hours later
Brief Answer:
Anemia, carbon monoxide poisoning, pulmonary hypertension can cause low DLC

Detailed Answer:
Thanks for your question on Healthcare Magic.
I can understand your concern.
Following are the causes (Pulmonary) for low DLCO with normal CT.
1. Pulmonary hypertension (idiopathic)
2. Emphysema
Following are the causes (non pulmonary) for low DLCO with normal CT.
1. Cardiac insufficiency (failure)
2. Anemia
3. Carbon monoxide poisoning
4. Bleomycin and amiodarone overdose.
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. Nagamani Ng
doctor
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Follow up: Dr. Kaushal Bhavsar 1 hour later

I have had intermittent shortness of breath for 1 1/2 years after getting iron infusions. I have a normal hemoglobin count, just low ferritin. My hematologist said a very rare reaction could cause pulmonary fibrosis but my HRCT was normal. I have had so many tests done (pulmonary and cardiac) and nothing significant has been found and they can't seem to find a cause for the shortness of breath. However, the DLCO was reduced on both PFTs I had done . So I was wondering ..Could a DLCO 60-75 % of predicted be considered normal or insignificant? Or is it something that should be followed?
doctor
Answered by Dr. Kaushal Bhavsar 24 minutes later
Brief Answer:
You should get done DLCO every 6 monthly.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Normal HRCT rule out pulmonary causes for low DLCO.
So no need to worry for lung diseases.
Less than 60% predicted DLCO is worrisome. But if you maintain DLCO of more than 60% predicted then no need to worry much.
So get done DLCO every 6 monthly to monitor it.
I want to ask few more questions regarding your low DLCO. But only if you allow.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Kaushal Bhavsar 5 minutes later
Yes you can ask anything. I am just trying to figure this out
doctor
Answered by Dr. Kaushal Bhavsar 2 minutes later
Brief Answer:
Where do you live?

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
Thanks for your permission.
Please let me know
1. Where do you live?
2. Do you live at higher altitude?
3. Are you obese?
4. Can you send me your DLCO report?
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. Nagamani Ng
doctor
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Follow up: Dr. Kaushal Bhavsar 22 hours later
1. Reading, PA
2. Not a high altitude
3. I'm not obese, my BMI is 19.5

Here is my PFT report:

FVC Measured     4.32 Liters     Liters
FVC % Pre Pred     99 %     %
FVC Post     4.23 Liters     Liters
FVC %PostPred     97 %     %
FVC % Change     -2 %     %
FEV1 Measured     3.65 Liters     Liters
FEV1 %Pre Pred     101 %     %
FEV1 Post     3.75 Liters     Liters
FEV1 %Post Pred     104 %     %
FEV1%Chng     3 %     %
FEV1/FVC Pre     84 %     %
FEV1/FVC Post     89 %     %
TLC Post     5.60 Liters     Liters
TLC %Postpred     97 %     %
RV Post     1.20 Liters     Liters
RV % Post Pred     70 %     %
DLCO Post     24.7 mL/mmHg/min     mL/mmHg/min
DLCO %Post Pred     78 %     %
DLCO/Va Post     4.12 mL/mHg/min/L     mL/mHg/min/L
DLCO/VA %Post Pred     72 %     %
PI XXXXXXX Post     88 cmH2O     cmH2O
PI XXXXXXX % Post Pred     102 %     %
PE XXXXXXX Post     107 cmH2O     cmH2O
Pe XXXXXXX %Post Pred     70 %     %
pre     2 %     %
VOL EXTRAP/FVC Post     2 %     %


My DLCO on the other was in the 60s. I do not have that report though.
doctor
Answered by Dr. Kaushal Bhavsar 17 hours later
Brief Answer:
No need to worry for this report.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
I have gone through the report you have mentioned.
Your all PFT parameters are normal. So no need to worry for low DLCO levels.
Please let me know
1. Do you have stressful life?
2. Where do you work?
3. Do you have workplace exposure with gases and chemicals?
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. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 1 hour later
My life isn't really stressful. I work in a hospital and I am not exposed to any gases or chemicals. This had all started after iron infusions. I felt like I had the flu after getting them and also began with delayed shortness of breath after the 2nd infusion. They stopped for a month for the concern of fibrosis but when my CT came back normal they started me again with a small dose. Later that night the shortness of breath happened again. But really it does not make sense medically that I would continue with the shortness of breath. It happens randomly and when going up an incline or stairs. I am seeing an endocrinologist soon because I have these episodes of a "fight or flight" response and slightly elevated norepinephrine and epinephrine levels. They are unsure if this is related at all.
doctor
Answered by Dr. Kaushal Bhavsar 6 hours later
Brief Answer:
You might have developed iron allergy.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
You might be having panic attacks. I am not sure but this is also one possibility.
Another possibility is iron allergy. It is rare today develop breathlessness as an allergic reaction to iron but it do occur.
I am thinking about allergy because your symptoms are starting only after iron injection and worsen on the day of follow up iron injection.
You can consult endocrinologist and if he doesn't find anything abnormal then possibility of panic attacks is more.
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. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Kaushal Bhavsar 16 hours later
It is not anxiety. I have seen a psychiatrist multiple times and he says its not psychiatric. I will follow up with endo. Thanks for answering all my questions.
doctor
Answered by Dr. Kaushal Bhavsar 5 hours later
Brief Answer:
Yes, you should definitely consult endocrinologist first.

Detailed Answer:
Thanks for your follow up question on Healthcare Magic.
I can understand your concern.
Yes, you should definitely consult endocrinologist first.
Sorry if I hurt you by saying psychiatric illness.
Hope I have solved your query.
If you are not having further queries, then please close the conversation and rate my answer.
You can ask me directly on bit.ly/askdrkaushalbhavsar.
Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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