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Moving Infiltrate in lower left lung
by Fun2feelfree, Nov 28, 2007 03:35PM
Hi,
I am a 27 year old male, residing in Amsterdam. I was otherwise healthy, until july 07 when i suddenly started coughing up flecks of blood with sputum. The sputum was slimy and salty. Sputum test didn't reveal anything. Blood test was normal. The GP advised some antibiotics (Amoxycilin, Ciprofloxacin) but nothing worked. I was referred to a lung specialist. A subsequent CT (on 23rd July) showed a small focal infiltrate (homogeneous opacity) in the left lung. It was not a mass. All meds were stopped. A bronchoscopy with bronchial washing and lavage was non diagnostic of any kind of abnormality, including bacteria or malignancy. A subsequent CT after 3 weeks showed the infiltrate moving a little down the lobe, and clearing on the initial position. The blood was less in the sputum, however it was periodical. After that we have taken 3 more CTs over the past 3 months, the infiltrate has always moved to different places in the left lobe, clearing out on the previous positions. But the salty sputum still persists. A recent CBC was normal, except ESR of around 9, and IgA of 4.25 with Billirubin of 18. Other than that, my weight has been stable, no fever and no pain. Recently also got some issue with fluid in my rt ear and little nosebleed. A repeat bronchoscopy with TBB with lavage also went non diagnostic. Lung Function Tests didn't reveal anything significant. The infiltrate still persists as evident from the last CT done on 5th Nov. I am terrificly anxious about BAC, which also gives salty mucoid sputum. Any idea on the probability of a malignancy?? Any other differential diagnosis??
I am a 27 year old male, residing in Amsterdam. I was otherwise healthy, until july 07 when i suddenly started coughing up flecks of blood with sputum. The sputum was slimy and salty. Sputum test didn't reveal anything. Blood test was normal. The GP advised some antibiotics (Amoxycilin, Ciprofloxacin) but nothing worked. I was referred to a lung specialist. A subsequent CT (on 23rd July) showed a small focal infiltrate (homogeneous opacity) in the left lung. It was not a mass. All meds were stopped. A bronchoscopy with bronchial washing and lavage was non diagnostic of any kind of abnormality, including bacteria or malignancy. A subsequent CT after 3 weeks showed the infiltrate moving a little down the lobe, and clearing on the initial position. The blood was less in the sputum, however it was periodical. After that we have taken 3 more CTs over the past 3 months, the infiltrate has always moved to different places in the left lobe, clearing out on the previous positions. But the salty sputum still persists. A recent CBC was normal, except ESR of around 9, and IgA of 4.25 with Billirubin of 18. Other than that, my weight has been stable, no fever and no pain. Recently also got some issue with fluid in my rt ear and little nosebleed. A repeat bronchoscopy with TBB with lavage also went non diagnostic. Lung Function Tests didn't reveal anything significant. The infiltrate still persists as evident from the last CT done on 5th Nov. I am terrificly anxious about BAC, which also gives salty mucoid sputum. Any idea on the probability of a malignancy?? Any other differential diagnosis??
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What you describe could be a fungal infection of the lungs or a carcinoma. But most probably it looks to be a fungal infection - aspergillus infection called ABPA - allergic bronchopulmonary aspergillosis or even an aspergilloma. You need to discuss these possibilities with your chest physician and see what he has to say. You would be advised to get some more blood tests like serum precipitins, SErum IgE and IgG against aspergillus species etc and some skin allergy tests done for this fungal infection to reach a definite diagnosis. The management in such cases is steroids started at a dose according to the body weight and dose altered according to the repeat blood tests and clinical response. Do schedule an appointment with your chest specialist and discuss this with him in detail. Goodluck.
I asked the doctor about the probability of a carcinoma, and they were of the opinion that since the infiltrate clears out on its own every 2-4 weeks from its previous positions and moves to a new position, it shouldn't be a carcinoma, since in that case, it can't move and clear out on its own. But i will surely talk to the doc about the probability of a fungal infection.
What were the serum precipitins levels and IgE & IgG levels against aspergillus levels? Had you got that done? You could get those tests done in the consultation with your physician. You could also get a repeat after scan a few months when your chest specialist thinks it appropriate. Discuss what differential diagnosis is your chest specialist thinking of in your case. Goodluck.
I think for now as all the tests are clear you just need to sit back and relax. Do follow uo with your doctor regularly and get a repeat CT in Feb. Also report any abnormal symptoms if you have to your doctor. Ask your doctor for some antinausea antireflux combination medications for the GERD. Goodluck.