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HR- CT SCAN Restrictive lung
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HR- CT SCAN Restrictive lung

Hi, I just have some questions with regards to HR-CT Scans.

1. How accurate are they at detecting restrictive Lung disease?
2. Can they detect inflammation in the lung?
3. If HR-CT are clear does this rule out RLD?
3. Would a MRI Scan be better at detecting Lung Inflammation or inflammation in the muscles around the lungs? or would you recommend a different scan for inflammation?

I have had PFT, are they show that my FVC FVC1 are at 62% but the lung specialists say this is due to the abnormal shape of my chest that I was born with. However I started getting chest pains in November also looking very pale, Constant Heavy chest. Hoarseness in my voice. I am a 23 yo male. previous smoker for 3 years smoking about 3 a day. I really do feel that this is a problem with my lungs however the doctors do not know what else to do. With you expertise, which investigation would you recommend I have next?


I am really grateful for any advise you can give.
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CT scans can be quite accurate in determining lung size.  Reduced lung size is typical with restrictive lung disease (RLD).  However, the best way to detect RLD is by pulmonary function tests (PFTs).  These are a variety of breathing tests that provide detailed information about how your lungs are working.  The numbers you gave would mean RLD only if both FVC and FVC1, more commonly referred to as FEV1, are 62%, with a FEV1/FVC ratio of 100%.  A common cause of RLD is a misshapen chest.  Most commonly this is due to an extreme forward curve to the backbone called kypho-scoliosis.  A clear high resolution CT (HRCT) scan only means that some specific types of RLD are not a problem.  However it does not mean that there is no RLD.

CT scans can indirectly detect inflammation when there is bronchial wall thickening.  An MRI scan is no better at detecting inflammation.  The best way to detect inflammation is by looking directly with a bronchoscope.  This thin flexible tube with a small camera at one end is passed through your nose into your windpipe to look into your lungs.  Along with this it is helpful to examine the bronchial secretions for cells and other biochemical markers of inflammation.  The 2 most common causes of bronchial inflammation are asthma and COPD.  Most often COPD occurs later in life after a long history of smoking.  Either of these diseases can occur along with RLD.

The voice hoarseness is not typical of RLD, with or without inflammation.  Voice hoarseness could be seen with RLD if there is compression of a major bronchus along with the recurrent laryngeal nerve.  You should have your voice box and vocal cords examined by an ENT or lung specialist using a small camera at the end of a flexible tube, called a fiberoptic laryngoscope.
2 Comments
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Hi,

1. How accurate are they at detecting restrictive Lung disease?
Very

2. Can they detect inflammation in the lung?
Yes if the inflamation (inflammation) is significiant

3. If HR-CT are clear does this rule out RLD?
Most likely, it will rule ou clinically significiant ILD

3. Would a MRI Scan be better at detecting Lung Inflammation or inflammation in the muscles around the lungs? or would you recommend a different scan for inflammation?

No and No, the only MRI available for this is undergoing trials and not available.

If ILD troubles you get a full PFT with DCLO, DCLO is always reduced in "Clinically Significant" ILD.

Your smoking history does not even put you on the radar. Stop smoking and excersise, you will feel better.

You are too young to have any of these problems without a disease process i.e.  a connective tissue type disease.

Rgds,

E.
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