Emphysemic changes vs. emphysema

[Eileen0422]

My primary called me with the results of my chest CT and referred to "emphysemic changes", among other things.  I obtained a copy of the report and the wording is "emphysema", not "emphysemic changes".  What is the difference and why would he use that term as opposed to what the report stated?  I am asymptomatic..the CT was done as a follow up to an incidental finding of nodule in the lower lung in 2004 during a hospital stay for a kidney infection.

Here are the impressions from the CT:
1. Biapical interstitial nodular prominence with right greater than left.  Similar findings were reported on a prior CT chest dated 4/29/02.  (Previously diagnosed in 2002 as Eosinophillic granuloma..quit smoking for a year and it reversed itself.  Have since gone back to smoking.)

2. Subcentimeter nodule in the right middle lobe and subcentimeter nodule in the left lower lobe.  Differential diagnosis includes infectious etiologies, or inflammatory etiologies.  By report, these nodules were not evident on the prior exam.  (Don't know if it matters, but I had a cold when the CT was taken)

3. Centrilobular emphysema.

4. 2.9 cm ovoid lesion in the lateral aspect of the right lobe of the liver.  A similar finding was reported on the prior examination.  This likely represents a benign finding. Further workup is recommended.

Is this a definitive diagnosis of emphysema?  Primary doc did suggest I see the pulmonologist, but he seemed rather unconcerned in general...I really got the impression he was just covering his own a**, to be honest with you.

Thanks for your help
Eileen

[National Jewish]

There is no medical difference between emphysema and emphysemic changes.  It is impossible to say that a person has emphysema based upon the chest CT scan alone.  This is not a definitive diagnosis of emphysema.  It just means that some areas of emphysema are seen on your chest CT scan.  So emphysemic changes is the most accurate term to use in describing your chest CT scan.  These changes, which include centrilobular emphysema, are typically seen with emphysema.  However, it is only possible to say that a person has emphysema based upon the results of pulmonary function tests (PFTs) along with the chest CT scan.  The amount and significance of what is seen on your chest CT scan can easily be determined by PFTs.  This is the gold standard for making the diagnosis of emphysema.

Please keep in mind that emphysema progresses 3 times faster in those who continue to smoke compared with those who never smoke again.  Whether or not you are given the definitive diagnosis of emphysema, please consider never smoking again.  Everyone in the United States has free access to telephonic counseling for quitting tobacco at Quitline (800) QUIT NOW.  You may want to look at our giving up smoking information at http://www.nationaljewish.org/disease-info/wellness/smoking/index.aspx for ways to help you quit smoking.  Also check with your doctor for other quit smoking resources in your area.

[EROS]

If your CT shows emphysema and you are really asymptomatic and you give up smoking now you should (witin reason, without taking into account age, smoking history, pft values etc.) remain asymptomatic.

Get a full pulmonary function test, this will tell you more about the status of your emphysema. CT's are used to confirm Emphysema after abnormal PFT's.

Many have abnormal CT's suggestive of emphysema but live normal lives.

Rgds,

E.

[Eileen0422]

Thank you for your reply.  It definitely cleared things up for me.  I have already taken steps to quit smoking again...started taking wellbutrin, got the nicotine gum ready and set a quit date of this Monday.  I did it before..I'm sure I can do it again!  I am seeing my pulmonologist in two weeks and I guess he'll put me through the paces again with the PFTs.  As I said, I am asymptomatic so I imagine they will turn out ok.

Wish me luck with this insidious addiction and thanks again.

Eileen

[Barbarella]

My husband too has a nodule in his lung, and "early stages of emphysema".  I guess since he was a 4 pack a day smoker for 40 yrs the Lung Specialist ordered a biopsy of the nodule.  It was BENIGN.  This "cancer scare" caused him finally to stop smoking.  Nothing helped him to quit EXCEPT for the Wellbutrin.  The nicotine gum did ZERO for him.  It took him one year on the Wellbutrin to get off the cigs.  It was very hard on him, and he still gets urges but not to the point where he reaches for a cigarette.  The people he works with all smoke around him so you can imagine that makes it even harder.  But he hasn't smoked a cigarette for three yrs now.  

Good luck to you.

[Eileen0422]

Thanks for the encouragement Barbarella.  The wellbutrin does wonders for me, also. It is already curbing my urges.  I was on it for 5 years, moreso for depression, but when I went off it last year, my smoking got totally out of control.  I went from smoking 1 pack a day to at least 2 packs almost immediately.  I am now back down to under a pack a day and still plan on stopping completely on Monday.  The gum has also helped me in the past.  When I quit for a year before, I don't think I would have made it through the first 3 months without it.  Also picked up some hand weights today and am very excited to start working out again!

I wish continued success to your husband!

Eileen

[Barbarella]

Thanks for your kind comment.  He almost started to smoke again one time when he went through a very stressful period, but he didn't.  It scared me. He told me about it.  I never asked him or was on his case about to stop smoking or asked him if he started to smoke again at work maybe.  I figured this is the worst thing I could've done.  

Don't ever smoke while you chew the nicotine gum.  He did that one time and got real sick to the point where I thought I would've to call the ambulance. His face was grey as ashes and he had a headache out of this world.

Hang in there.  You will make it!  Don't get discouraged if you have a setback.

[Babs1176]

Anyone know about this change on CT in NON SMOKERS?!?!?!?

I am a non smoker and have had this on my chest CT!

[conniegthr]

my husband smoked up to 3 packs of cigarettes a day and in feb of 2006 he went to work one morning and had a massive brain hemmorage he almost died but now he is unable to walk ,talk and one eye is partially sewn shut ,plus his throat is parralyzed so he chokes very easy,it is a total nightmare on him and for me because I am his only caregiver and I work everyday grooming dogs so he goes with me ,it is really taking a toll on me ,I can tell.
I also smoked for some 30 years but I started chewing the nicotine gum and have not smoked in 6 years but still have real bad breathing problems very short of breath ,smoking is the worse thing we can ever do to our body I truly believe that and it is soo addictive