explanation of test results

[dmoore80]

Could you please clarify some radiology terms for me. I am a post-esophagectomy patient; breast cancer patient w/implants 18 months post-chemo; and ex-smoker who quit in 2005, but prior to that, smoked for 24 years. I have difficulty breathing, some labored breathing going up stairs and when exherting energy, which I mostly attributed to the fact that after they took my esophagus out they pulled my stomach up to use it as my new esophagus so now it shares a bit of space with my heart and lungs. But its getting a bit harder, but I've had additional surgeries since then. Few weeks ago, incidental finding on a shoulder xray, small nodule on my right lung, so they did an Apical lordotic view and also AP & lateral views of the chest. They said it was compared to chest  xray done last year  for pre-op before breast reconstruction for implants surgery. This report says There is "minimal scarring and some thickening of pleura in the right apex." I know scarring can be from an old infection. But thickening of pleura, what can cause that? I know it can be a sign of cancer, and with my history of it, I am a bit concerned. It also said there is "blunting of both pleural diaphragmatic sinuses due to adhesions." I have no idea what that means. Can you please help clarify this for me.  It mentions the bilateral breast implants and evidence of previous surgery in the neck area (esophagectomy). And in the conclusion adds no change since previous examination done one year ago. But when I read that report from one year ago, it never mentioned any of these findings.  Thank you in advance for your time.

[National Jewish Health]

Two main concerns at this time:  1) labored breathing and, 2) the X-ray changes of “minimal scarring and some thickening of pleura in the right apex”. The latter, the scarring of the apical (top) portion of lung and adjacent pleura is common and, as you suggest, almost always indicative of past infection (often TB) and of no consequence.  It is much less likely a sign of cancer.  A CT scan of the area could further define the “scarring”.  The more important and encouraging finding is that there has been “no change” over a period of one year, such stability highly unlikely if this were tumor.  Stability after two years is generally considered to be definitive evidence of non-malignant disease.  That the findings were not mentioned one year ago suggests that these are minimal changes, commonly seen and not worthy of mention.  The “blunting” at the junction of lung and diaphragm is, as suggested, most likely due to adhesions (scar tissue) and, unless acute or progressive, is not normally of concern.  It should be followed-up with another chest X-ray if new symptoms develop or at 3 months in the absence of new symptoms.

The labored breathing may be an indication of lung damage secondary to smoking and possibly also to chemotherapy and it should be evaluated by one familiar with such lung disease. They need  to determine if there is evidence of loss of pulmonary function and also to decide if inhaled bronchodilator medication might provide some relief.  You should pursue this question and the questions addressed above, with a lung specialist (pulmonologist).

You have been through a lot and are obviously a “fighter.”  Good luck

[dmoore80]

Thank you for your thorough explanation. The surgeon had to cut my diaphragm to remove my esophagus and pull up the stomach, that's probably where the adhesions are from. I didn't know it was located so close to the lungs. I will get a referral to a pulmonologist and get a ful work-up to include a PFT. Thank you for the acknowledgement and well wishes...it's been a long journey.