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lung x-ray
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lung x-ray

My mother (68 yrs) had pneumonia with back pain back in February.  At that time her pulmonologist did a chest x-ray.  She finally showed me the test result and it revealed a "4cm mass in lower left lobe".  She says that after the round of meds, she went back and he did another x-ray ant it came back clear.  My question is this---why would the original x-ray show a "mass" as opposed to "fluid" or "shadow".  Her symptoms from the pneumonia have gone...no back pain, no fever, etc. Her other asthma related symptoms have not gone away, nor gotten any better even with the large quantity of daily meds she takes (prednisone--for the past 6 months with no improvement; combivent (terrible reaction--stopped); albuterol inhaler; albuterol & ipratropium bromide in nebulizer; singulair; nasonex; etc).  Her wheezing never goes away and she went from walking 4 miles a day (for almost 10 years) to not being able to walk to the corner of the street.   Her symptoms have been bad for close to a year.  This is her 2nd bout of pneumonia in 6 months and she appears to be getting worse with her asthma and not better.  Any ideas or recommednations would be great.  Should I be concerned about the "mass"  or is it an acceptable term for "fluid in the lungs"?  Thanks so much!!
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The X-ray findings of a "mass", with pneumonia, are not rare.  The pneumonia itself, if very dense, can resemble a mass.  Sometimes a walled off collection of fluid secondary to the pneumonia, can take on the appearance of a mass; a so-called pseudotumor.  This if of interest but the most important thing is that, according to your report, the "mass" is gone and that definitely excludes the possibility that the "mass" was tumor, especially if the repeat X-ray shows complete resolution of pneumonia.

Since this was her second pneumonia in 6 months, it would be important to know if both pneumonias were in the same part of your mother's lung.  If so, the possibility exists that both pneumonias were set-up by a tumor that was not evident on X-ray.  You should check with her pulmonologist on this.  If both pneumonias were in the same lobe of her lung your Mom may need to have a bronchoscopy.  This would be especially important if her wheezing were unilateral and best heard over the lung which harbored the pneumonias.

The poor response of your Mother's "asthma" to prednisone and the other asthma drugs should raise doubts about the diagnosis of asthma, especially if the asthma was of relatively recent onset.  Not everything that wheezes is asthma and a number of conditions, including tumors of the trachea or large airways, can cause wheezing and mimic asthma. Such "central tumors" are often not evident on chest X-rays.  This could account for her rapidly progressive worsening of the "asthma", and her atypical, dramatic decrease in exercise tolerance, over the short period of one year. This could be another reason for her to have a bronchoscopy.

There is also a condition called "cardiac asthma"; that is, wheezing in response to congestive heart failure. It is worth noting that recurrent pulmonary emboli (clots to the lung) can also present with wheezing and severe shortness of breath.

You should consider sharing the above with your Mother's physician and question the diagnosis of asthma.
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