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What does "large and dense opacity in right lower lobe with costophrenic angle" mean?

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Internal Medicine Specialist
Practicing since : 1980
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Hello, xray shows large and dense opacity in right lower lobe with costophrenic angle suggestive of consolidation with pleural effusion rest of the lung shows increased broncho vascular markings and intestitial shadows.Please can u tell me what is the diagnosis for this
Posted Sun, 23 Feb 2014 in Lung and Chest disorders
Answered by Dr. Rakesh Karanwal 41 minutes later
Brief Answer: Please upload Page 2 of CT Scan report Detailed Answer: Hi XXXX Thanks for your query. Firstly, HRCT scan chest report is incomplete. Further, there is a great variation in the X-ray and CT scan findings. CT scan- being more sensitive and specific than a conventional X-ray- does not show either a consolidation or, pleural effusion (fluid in the pleural cavity which surrounds the lungs). The findings are that of pleural wall thickening, which occurs due to solidification of infective fluid some time in the past (usually tubercular). Also, CT scan report makes no mention of the enlarged lymph nodes. Perhaps, Page No. 2 of the report may have some useful information. Overall, the x-ray and CT scan findings are suggestive of mild damage to the lung tissues on account of a past infection (most likely Tuberculosis) and age-related. Lastly, the findings of enlarged lymph nodes in X-ray (in an 83 years old male) may be due to either Tuberculosis, sarcoidosis or malignancy. The exact cause can only be ascertained following further relevant tests for each of the possibilities. No further opinion can be offered at this stage, in the absence of the complete CT Scan report. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal
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Follow-up: What does "large and dense opacity in right lower lobe with costophrenic angle" mean? 15 hours later
Thank u Dr -have attached both sides of the report.Post this we had done Tb culture which was normal even the 6 week one.This scan was Oct by Nov end he contracted pneumonia klebsella. Post which he was treated in hospital but the lung retained a slight haze. Bronchoscopy was also done but didnt show any major issues. My question is: was cancer the only other test which we needed to do? His breathing deteriorated on 25th dec and he had to be put on ventilator on 26th he passed away.We have not been able to get closure and wonder what the reason was and a month back he seemed totally ok
Answered by Dr. Rakesh Karanwal 8 hours later
Brief Answer: Underlying cancer is a strong possibility Detailed Answer: Hi XXXX I have gone through the CT Scan report. 1. Klebsiella Pneumonia has a high mortality rate. The possibilities are that it was a severe infection involving lungs extensively; or, the response to antibiotics was inadequate and the patient suffered respiratory failure. 2. The commonest causes of significantly enlarged lymph nodes in the lungs are:- Lung Cancer, Lymphoma (cancer of the Lymphatic system) or due to spread of cancer cells from a distant cancer. Hence, a biopsy of the affected lymph nodes would have identified the underlying/undetected condition. 3. Another common cause is Sarcoidosis (as suggested by the Radiologist), an auto-immune condition (disorder of the immune system of the body). 3. Apparently, the patient's rapidly deteriorating condition prevented the treating doctors from conducting a biopsy. The cause of death was most likely due to complication of Klebsiella Pneumonia. Take care, Col (Dr.) Rakesh Karanwal
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Follow-up: What does "large and dense opacity in right lower lobe with costophrenic angle" mean? 33 hours later
Thank u last question. We did the Ct scan in Oct and waited for the TB culture which was due in Nov end.Post which we were planning Ct biopsy and or bronchoscopy. In this period of 1.5 months......did the Ct indicate pnemonia or is that something else he contracted. Should he have been on bed rest and not gone out at all in this period..........since Tb was negative we assumed its not so serious in that phase. Plus if u say cancer then we delayed the Ct scan right..........if it was done earlier would cancer have been cured/controlled. In ICU the infection was controlled and wbc came down to 10 and later 6 he was going to be shifted to the ward when last 2 days he suddenly could not breathe properly and was going to be intubated when he passed away due to sudden dip in bp and cardiac arrest.
Answered by Dr. Rakesh Karanwal 1 hour later
Brief Answer: Underlying lung disease + Klebsiella caused death Detailed Answer: The findings of CT scan done in Oct, were suggestive of Nonspecific Scarring interstitial pneumonia (NSIP), a disorder of unknown cause, that affects the tissue that surrounds and separates the tiny air sacs of the lungs. These air sacs, called the alveoli, are where the exchange of oxygen and carbon dioxide takes place between the lungs and the bloodstream. Due to scarring of the lung tissue, exchange of oxygen and carbon dioxide becomes much less effective. The patient had apparently had a superimposed Acute Interstitial pneumonia (DUE TO AN UNKNOWN CAUSE- Called IDIOPATHIC)- a disease in which the mesh-like walls of the alveoli become inflamed. It usually affects otherwise healthy individuals. The individual had contacted Klebsiella Pneumonia in the background of the underlying scarring of the lungs (and also probable cancer/lymphoma). As a result, the mortality rate increased manifold. It would be unreasonable on my part to state that he should have been on bed rest in the interim period, pending receipt of TB culture report. But, YES. He did contact Klebsiella infection at a later stage, which accounts for rapid deterioration in his condition. It would be grossly unfair on your part to feel guilty for the delay in getting a CT scan done, as he was in good health and there was no apparent reason for you to suspect cancer. Further, if at all, there was a silent cancer (without any symptoms), it was already in an advance stage, with a poor prognosis and no cure. Lastly, he had- following clinical improvement- most probably developed Acute Respiratory Distress Syndrome (ARDS) all of a sudden- a consequence of interstitial pneumonia + Klebsiella Pneumonia- which culminated into death. Take care Col (Dr.) Rakesh Karanwal
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