Pneumonia won't clear

[mommyconcerned]

My son has had pneumonia since March. He never presented with any symptomns other than severe back pain which resulted in an ER visit. At the ER a chest x ray and then CT scan confirmed a mass in his lower left lung. After visiting pulmonologist he was given a pulmonary function test on which he was at 37% of normal function. He completed 3 separate courses of antibiotics BIAXIN, ZITHROMAX, and CLINDOMYCIN. After a second and then third chest xray his inflammation marker in his blood is finally normal but as of June he is still showing mucus in his lungs on chest x ray and is only at 67% lung function. He is now doing Symbicort 4 puffs a day and Albuterol for occasional use. We will repeat another Chest x ray on the 10th of August. Is there something else we should be looking at? Dr. already checked for CF, RA, and did lymph node scan. Is this a type of atypical pneumonia or something else?

[National Jewish Health]

What you relate is complex and a bit confusing.  One does not usually refer to pneumonia as "a mass".  If there truly is a mass in your son's left lower lobe, then it and the pneumonia are probably related and the mass the factor that predisposed him to pneumonia.  And, if there is a mass, the nature of the mass must be determined unless it has gotten smaller with treatment of his pneumonia.  If it is the same or larger, bronchoscopy would be the diagnostic procedure of choice.

Lung disease limited to one lobe, in this case the left lower lobe, does not cause a reduction of pulmonary function to 37% of predicted.  You should ask the pulmonologist to provide his/her best guess as to the cause of diminished lung function.  The medicines he is receiving suggest that he has obstructive lung disease and, assuming that he is relatively young, the most common cause of obstruction to airflow is asthma but there are other causes, including cystic fibrosis (CF).  You might also want to ask what type of test was done for CF and the likelihood that it could be falsely negative.

Four to five months is a long time for infectious pneumonia to resolve.  You should ask the specialist what type of infection would do this and why it did not resolve more quickly.  Finally, you might want to ask, 1) if his might be a non-infectious pneumonia or due to aspiration, and 2) if infection with a fungus is a possibility.

It is not clear why his doctors want to wait until August to get another x-ray.  You may want to consider getting a second opinion from another pulmonologist.