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Dr. Andrew Rynne

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What does this CT scan report indicate?

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Dr. Jnikolla

Pulmonologist

Practicing since :2003

Answered : 1347 Questions

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Posted on Wed, 9 May 2018 in Lung and Chest disorders
Question: Hi,

Initially I had some right sided chest pain which I suspected was related to GERD and wanted to investigate further without doing a gastroscopy.

I was advised for a CT and the report result reads:

There is a cluster of ill-defined nodules in the apical segment of the left lower lobe. There is no evidence of cavitation or calcification. The rest of the lungs are clear. There is no pulmonary consolidation, pneumothorax or pleural effusion.

The airways are patent. Incidental note of the posterior segmental bronchus of the right upper lobe, arising directly from right bronchus intermedius.

There is no mediastinal, hilar or axillary lymphadenopathy. The heart size is within normal limits. There is no pericardial effusion. The visualised upper abdomen is unremarkable.

No rib fracture, rib lesion or chest wall abnormality is detected. No significant bony abnormality is detected.

IMPRESSION

The cluster of ill-defined modules in the apical segment of the left upper lobe is likely inflammatory/infectious. Specifically, TB should be considered.
There is no cavitation or lymphadenopathy.


I had a sore throat roughly a week before doing this CT with low grade fever but initially no sputum production. However, there was sputum produced on the day of this CT scan but previously there was basically none.

I have done some initial tests on sputum for TB. The results were as follows:

28th Nov
Direct smear AFB (ZN Stain)
No Acid-fast bacilli seen

Gram Stain
Pus cells (+++)
Epithelial cells (few)
Gram positive rods (+)

Culture lower respiratory
No growth of pathogen


29th Nov
Smear Acid Fast Bacilli, No AFB seen

Culture, sputum final, No growth of pathogen

Gram Stain Final
White blood cells, Seen (3+)
Epithelial cells, Seen (few)
Gram positive cocci, Seen (1+)


30th Nov
TB Probetec
M. Tuberculosis complex DNA not detected
Nucleic acid amplification test results are preliminary, pending culture results.

METHOD: Strand displacement amplification (ProbeTec DTB Assay)
GENE TESTED: IS6110

COMMENTS:
A negative result does not exclude the possibility of low concentration of MTBC DNA, or MTBC variants that lack the IS6110 gene.

Performance data for smear-negative respiratory (n=83) and non-respiratory (n=422) samples

Respiratory specimens Non-respiratory specimens
ST 14/15 93.3% 31/31 100.0%
SP 68/68 100.0% 389/391 99.5%
PPV 14/14 100.0% 31/34 91.2%
NPV 68/69 98.6% 388/388 100.0%

Performance data for smear-positive (respiratory and non-respiratory) samples (n=55)

ST 46/46 100.0% PPV 46/46 100.0%
SP 9/9 100.0% NPV 9/9 100.0%

Please correlate this result with clinical, radiological and other laboratory findings.


Are there other tests that can be recommended for TB or should these tests be enough? Should I expect further culture results or do these culture results appear final?

Why is the quantiferon Gold test considered of limited value in many parts of the world? Should I have this test?

What could be other causes of the CT scan findings?


Thankyou.














doctor
Answered by Dr. Jnikolla 41 minutes later
Brief Answer:
Probably PPD skin test

Detailed Answer:
Hello and thank you for asking in HCM

I can understand your concern

As you explain the history the fact that the direct smear AFB (ZN Stain) is negative means that in your organism there are not bacilli of tuberculosis in active status. However the culture of the secretions is the best examination for excluding completely it (which needs 4-6 weeks for the result). M. Tuberculosis complex DNA test - negative is although a good sign that relates with the above.

If you were my patient i would first recommend you to do a simple PPD skin test. If this test is negative then no another test for tb is needed to do further . If positive than direct smear AFB (ZN Stain) and DNA test are indicated (you have already done them).

I do not recommend Quantiferon B for you. It is mainly for latent TB and in your case it would be negative too (good sign).It is considered of limited value in many parts of the world especially in countries with high incidence and prevalence of TB.

Other causes of the CT scan findings might be other non tuberculous mycobacteria infection of the lungs.

According to the history you provide it might be a past infection which had left a sign in your lungs but no need to worry about.

Please discuss with your doctor for the above

Regards and feel free to ask me again

Regards

Dr.Jolanda
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Jnikolla 53 minutes later
Thanks Dr. Jolanda,

I will consider the simple skin test perhaps as further confirmation. Could you explain why the Quantiferon B test is of limited value in the cases of high incidence of TB? Can it distinguish between active and latent infection?

What sort of other tests can be done to find whether other mycobacteria are infecting the lungs currently? Would the culture of sputum or gram stain normally pick these up and should I also wait a few weeks to see the final culture results to find out if there are other bacteria in the lungs? Or do the culture tests normally specifically only try to culture one type of bacteria?



Thankyou.
doctor
Answered by Dr. Jnikolla 1 hour later
Brief Answer:
continue discussion

Detailed Answer:
Hi again

Quantiferon test is of limited value in countries with high incidence of tb because subjects in there have already high possibility to have encountered bacillus of tb during their lifetime.
It distinguishes the activation of latent tuberculosis in patients who have had tb before.

I suggest you to wait till the culture result which in se might have seen if there are different mycobacteria from tb ones.

Hope to have been helpful

Regards

Dr.Jolanda

Above answer was peer-reviewed by : Dr. Prasad
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E mail: YYYY@YYYY

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