CT Scan of Chest Interpretation

[MarisaV]

Recently I've been having issues with extreme fatigue, and shortness of breath. I have to fight for breath when lying down, and have to sleep sitting up.

I had an echocardiogram that said everything looked normal with my heart, the only exception being a calculated higher than normal pressure in the pulmonary artery. I went to see a Pulmonologist, and he wasn't concerned with it.

I had a pulmonary function test (closed booth), and the only thing abnormal was a 20% less volume in my lungs than expected. The Dr. said it could be a restrictive lung disease (scar tissue, somewhere, restricting my lungs from utilizing their full capacity)

I just obtained a copy of my recent CT scan of my lungs and the final impressions are listed as:

1. diffuse areas of air trapping bilaterally.  Some subtle ground-glass opacities within both lower lobes

2. Mild fusiform aneurysmal dilation of the ascending aorta measuring 4.1-4.2cm maximally

Since I don't see my Pulmonary doctor for another 3 weeks, I was wondering if any one can interpret what this means. Obviously, there's an aneurysm starting to be formed in the ascending aorta (won't be called an aneurysm until it reaches 4.5cm in diameter)... but, what's the big picture here??

Thanks. Any help is appreciated

Mar

[David Tinkelman, M.D.]

The CT findings are non-specific but the air trapping and ground glass opacities are definitely abnormal, most often with a diffuse interstitial lung disease (ILD).  Many, but not all, persons with ILD are smokers.  This is a restrictive lung disease and would be consistent with the pulmonary function abnormality you describe.  These diseases, with rare exceptions, present with a gradual worsening of shortness of breath but, frankly, the severe shortness of breath you have experienced and the fatigue appear to be out of proportion to the pulmonary function abnormality and the CT scan abnormalities.  

Your symptoms, but not your CT findings are consistent with heart failure for, with heart failure, one would expect the ECHO to have shown abnormal left ventricular function (pumping of systemic blood).  Note, a normal heart size does not rule out heart disease as one can have a normal heart size, with a marked reduction of blood flow, with a condition called constrictive pericarditis.  You might want to ask your cardiologist about this diagnosis and if the ECHO findings would rule out this diagnosis.

The normal ascending aorta is around 3.5 cm at its widest point and is generally not considered aneurismal until it enlarges to a diameter 1.5X the maximum normal value.  Your cardiologist could best discuss the extended criteria and the pros and cons of surgical intervention, but at 4.1 cm, you would not appear to be a candidate for surgery.  And, in any event the dilated aorta would not be a cause of your shortness of breath and exhaustion.

The suggestion of pulmonary hypertension is intriguing, not because of the severity (“higher than normal”) but because it is present at all and, given your symptoms, would be consistent with the diagnosis of recurrent blood clots to your lungs (recurrent pulmonary emboli), that might not be evident on either X-ray or CT Scan (depending on the technique used.)

Aside from your symptoms, there is no urgency to establish the diagnosis of interstitial (or other) lung disease.  It would be an urgent matter to establish the diagnosis of pulmonary emboli, however, and hypoxia (low blood oxygen level), be either one or both present.  I suggest that you discuss this question with your physicians, without delay.

Good luck

[MarisaV]

Thank you.

Bizarrely enough my oxygen levels are normal. The CT Scan was a high resolution scan without contrast.

A little over a month ago I had an incident that sent me to the emergency room. I became extremely short of breath all of a sudden (while sitting at my desk). I became very anxious, and started pacing back and forth, I had a feeling of dread. I called my doctor and he said to go to the ER.

The ER did a quick ECG/EKG and found nothing wrong. Oxygen levels were normal (crisis had passed, quite frankly, by the time I made it to the ER).... but fatigue and chronic shortness of breath got much worse after this incident. Doctor diagnosed me with a panic attack. my doctor prescibed lorazepam, for anxiety. I had a second incident of this 4 days later, that was milder, but lasted longer. I took my pulse duiring the second incident and it was around 60 (normally its around 80).

Forgot to mention that I'm a 52 year old Female.

Thanks again for your help

Mar