Chest CT Results Interpretation

[ka217]

Here's a little history - 31 year old female, smoker of about 1/2 pack per day for 13 years. I have been having chest and back pains for about 5 years and have had numerous tests done. Last week, I asked for a chest CT.
FINDINGS:
No acute bony abnormalities are identified. The thoracic aorta is not enlarged.  The visualized portions of the upper abdomen are notable for only vague decreased CT attenuation in the vicinity of the falciform ligament likely indicative of focal fatty infiltration. The adrenal glands appear normal. No upper abdominal adenopathy is evident.
The heart is not enlarged and there is no evidence of a pericardial effusion. No dominant thyroid bed mass lesions are observed. There is mild mediastinal adenopathy. Findings include but are not limited to an 11x9mm right paratracheal lymph node on series 2 imaged 15, a 13x10mm right paratracheal lymph node on series 2 image 22, a 15x8mm paraaortic region lymph node on series 2 image 24, a 15x11mm precarinal lymph node on series 2 image 26, and a 2.3x1.5cm subcarinal lymph node on series 2 image 31. Small bilateral hilar lymph nodes are evident. No axillary adenopathy is observed. The surrounding thoracic soft tissues are without focally concerning abnormality.
The tracheal air column is widely patent. No endobronchial lesions are identified. no pleural effusion or pneumothorax is evident. There are several scattered 5mm or less foci of juxtapleual and parenchymal nodularity bilaterally. These may be postinflammatory. The findings are noted in association with vague patchy areas of ground-glass CT density within the upper lobes bilaterally. Similar-appearing features of the periphery of the loeft lower lobe are seen on series 3 image 43. The remainder of the exam is unremarkable.

To be continued...

[ka217]

Thank you for your reply.  It's much appreciated.  

Do you think this chest pain, etc could be cause from cardiac issues?  I can't get any doctors to take me seriously because of my age!

[David Tinkelman, M.D.]

The majority of the findings on your CT scan are normal.  The exceptions are the “ground glass” shadows in the upper lobes (“vague patchy areas of ground-glass CT density within the upper lobes bilaterally.”), and the enlargement of lymph nodes in the central part of your chest.  These are non-specific findings and unlikely to be associated with the long time chest pains you have experienced, “for about 5 years.”  There are many possible causes of lymph node enlargement in this part of one’s body.  This is best summarized by Impression #4 below that refers to their being “non-specific”, infection, inflammation and tumor .  What the radiologist is saying is that it is not possible, on the basis of the scan results, to provide a specific diagnosis and what is implied is that it may be necessary to obtain a biopsy of one or more of these nodes.  That is simply because there limits to what even an expert can conclude on the basis of CT findings.  The good news is the existence of all the normal findings listed in this report.

Unfortunately that interpretation, while valid, understandably can provoke a lot of anxiety and I am sorry that you have to experience that.  The best way to deal with that is to arrange to see a pulmonary specialist as soon as possible.  He/she may not be any more specific than the radiologist, regarding the CT findings, but may be able  to offer an opinion as to the most likely cause(s).  One possibility may be the recommendation that no invasive testing be done until you have the results of a repeat CT scan.

Good luck