Interstitial Lung Disease after Pulmonary Emboli?

[qwertypop]

I was hospitalized in July (2006) for Pulmonary Emboli (several in both lungs) and have been on warfarin ever since.

About 6 weeks after I got out of the hospital, I developed some new symptoms like shortness of breath and chest constrictions; At first it was just during physical activity, and then it was random. An echo, chest x-ray and chest CT were all normal. A PFT showed "bronchial constriction" which was diagnosed as asthma by some random pulmonologist who read the test, but did not examine me or have my history.

The pulmonologist I DID see ran with this diagnosis and prescribed Singulair. The Singulair interrupted my sleep, so now I'm trying Pulmacort.

I wake up feeling fine, but by noon my symptoms are back. They include shortness of breath and chest tightness with occasional pleuritic pain my chest, flank or back, occasional dry cough, especially when lying down Occasional difficulty speaking. I experience symptoms when I am at rest or active.

I am dubious about the asthma diagnosis because the symptoms don't match mine. I don't wheeze, and no doctor has heard a wheeze. I don't produce mucus. I don't have attacks - I'm just symptomatic, or medicated. The symptoms aren't triggered - they are just *there.* Asthma is not a likely outcome of having had PE.

I'm wondering if this could be Idiopathic Interstitial Lung disease? I can't find any reference to it being the result of Pulmonary Embolism, but since it can start with random lung tissue damage, I don't think it's that far fetched.

Thanks in advance for your help.

[National Jewish]

Some people may develop bronchial constriction in response to pulmonary emboli (PEs).  However, this is not asthma.  Even though your echo, chest x-ray and CT scan were normal, your symptoms suggest recurrent PEs.  This would be much more likely than idiopathic interstitial lung disease with your normal CT scan and your recent PEs.  Some of your symptoms could also be from pulmonary hypertension caused by the PEs.

While highly sensitive, a CT scan will rarely be normal when PEs are present.  You should have another chest CT scan, specifically a helical or spiral CT.

A blood test called D-dimer is also a helpful test to find blood clots.  This testing has proven to be highly sensitive, but not specific.  So problems other than blood clots may be identified.  However a normal D-dimer is strong evidence against blood clots.  Its value is often limited to exclusion of blood clots.

Pulmonary embolism (PE) is a blood clot in an artery of the lungs.  The most common place for the clot to travel from is a vein in the legs.  Most of the time clots are due to some type of trauma to the legs, like a broken bone.  However the clot could also come from a vein in the pelvis, the arm, the shoulder, the chest, or even the heart.  Blood clotting problems can also cause blood clots to form in the lungs.

Your doctors need to determine why you had the clots in the first place.  This would be especially important if you have had further clots while on warfarin.  Finding the cause may require a complex work-up.  This would include a careful assessment of your blood clotting.  A doctor that specializes in this kind of problem is called a hematologist.  Check with your doctor about his/her recommendation of the appropriate specialists.  You may have to go to a university medical center for this expertise.  PEs can be life-threatening.

[Between]

Hi,
If you had idiopathic is would of showed on your ct scan. Have you had a stress test? And did you get the results from your pft?

[qwertypop]

Hi, and thanks for posting.

I have not seen the results of my PFT, but was told by my primary that it showed "Bronchial Constriction" which was diagnosed as asthma.

I have not had stress test; I had an echocardiogram that was normal.