lung spots

[hotmamma]

Hi I am 38yrs old had a chest xray and CT scan and they found patchy airspace disease in the infrahilar regions of both lungs.  This has been going on since October 2007.  I was admitted in to the hospital after having a broncospy.  I had complications the passage way was very narrow.  He had a hard time getting in.  My asthma got worse they admitted me and after two days was admitted to the cardiac intensive care unit.  As my heart rate increase and my chest had this heaviness feeling.  They told me these spots on my lungs were causing a collapsed lung.  They put me on prendsone and zinthromax was in hospital of 18 days before being discharded they ran quite a few tests like bone scan ct scan tb blood test.  All but the tests except the ct scan came back neg.  The ct scan still had the spots and they ordered a bed side pulminary function test.  which set me back as they almost intibated me.  After several treatments of ventolin I was fine.  I would like to know what this is on my lungs as the respirologist doesn't have a clue.  He thought 99% that the prendasone would work to clear up everything.  Being on 4 courses of heavy antibotics they are unsure.  Any clues.  

[hotmamma]

Thanks so much for the answer.  Isn't a broncospy a biopsy?  That test came back negative I think.  Here are the results:  Bronchial brushings right lower lobe no maligant cells respiratory cells identified.  Bronchial bushings left lower lobe no maligant cells respiratory cells identified.  Bronchioalveolar lavage left lower lobe no maliganant cells respiratory cells and abundant histocytes.  Cell count as follows Macrophages 90%, neutrophils 5%, Lymphocytes 5%.  Bronchioalveolar lavage right lower lobe no maligant cells.  Could you tell me what this means.  I am going now to a larger University hospital of Toronto Wetern Hospital down town.  Hopefully they will help me but I am very concerned as I had another CT scan and it changed again more spots on the lungs.  Please help me understand what this could be.  Thanks so much

[National Jewish Health]

It is unclear what is going on, even from what you have described in some detail.  Patchy airspace disease is an acceptable descriptive term, but it is not a diagnosis.  And, 18 days in the hospital is a long time and suggestive of serious disease.  Your doctors have ordered a lot of tests.  You should ask them what they suspect, especially with the tuberculosis (TB) testing.

If after several weeks of Zithromax® (azithromycin) and prednisone, the "patchy airspace disease” has truly not resolved and all cultures are negative, you will probably have to have a lung biopsy to accurately diagnose this condition.  This is especially so since, this disease has been going on for over 4 months.  The airspace disease could be infectious or a non-infectious, even an auto-immune disease.  You should request a second opinion from a pulmonologist and ask if it might be feasible to do a biopsy, via video assisted thoracic surgery (VATS).  If the answer is no, you must then ask what, then, is to be done to make a diagnosis.  You might even have to seek consultation at a larger medical center, possibly associated with a university.