Hi, I recently had a cxr & dr called me back in as it showed bilateral upper hyperinflation and multiple bullae most likely due to asthma, as well as old pulmonary fibrosis, fissure and diffuse interstitial thickening. Radiologist on report recommended pulmonary function tests and HRCT.
I am a 35 yr old female who has been smoking on and off since age 12. Currently on Champix and trying to quit again. Chronic chest and sinus infections prob. due to smoking.
Dr says concerned about the part that says there is interstitial thickening. Asked him if should be concerned about lung cancer (grandmother died from it even though never smoked), and he said to wait till ct results. Says many things can cause interstitial thickening. He doesn't think it is infection. Had CXR as originally thought had chest infection and 3 diff. antibiotics later still coughing, have sweats, chest pain, and short of breath, palpitations, etc.
Is this interstitial lung disease a huge concern for me? If I can finally quit smoking will that fix the thickening?
I agree with the recommendations of Pulmonary Function Testing and CT scanning of the lungs. The X-ray findings you describe: hyperinflation, diffuse interstitial thickening (fibrosis) and multiple bullae are all consistent with the diagnosis of COPD, a chronic lung disease strongly associated with cigarette smoking but, also associated with having a strong family history of emphysema, chronic bronchitis or COPD.
The demonstration of findings of COPD at your young age of 35 is worrisome. The premature onset (before age 40-50) of COPD is seen, 1) when there is a family history of such and, 2) in the presence of an inherited condition called, Alpha-one Protease Deficiency. Another chronic lung disease, bronchiectasis has also been reported with this deficiency state and is characterized by alterations in the size of the bronchial tubes, chronic cough with sputum (and sometimes recurrent bloody sputum) production and recurrent lung infection. The changes of emphysema (hyperinflation and bullae) are predominantly but not always present at the lung bases (lower lobes) but can occur in the upper lobes, albeit less often.
It is not necessary to consider other diagnoses such as Idiopathic pulmonary fibrosis or cancer to explain the interstitial changes (fibrosis) seen on your X-ray. Other than this, there nothing on your X-ray (as described) to suggest cancer.
That your symptoms persist suggest respiratory infection either, 1) with bacteria, insensitive to the prescribed antibiotics or, 2) interference with the healing process by continued smoking. I strongly encourage you, with the assistance of your doctor, to do everything in your power to stop smoking.
The interstitial lung disease component of this illness is concerning as a sign of smoke induced lung damage but not necessarily of the concern associated with interstitial changes with fibrosis seen when the primary disease process is fibrosis.
More information is needed (CT and PFT’s) and I recommend that you and your doctor seek the opinion of a lung specialist (pulmonologist) when these studies have been completed, to determine with reasonable certainty, what is the primary pulmonary disease process and what can be done about it.
The key goal at this time is to prevent further lung tissue damage by the inhalation of cigarette smoke and/or the inhalation of industrially polluted air. Whatever work you do, from this point on, must be performed in a clean air environment.
Thank you so much for your detailed response. I am definitely trying my best to quit smoking and I am on Champix to help. Still waiting for appt for the CT and lung tests. I will speak with my Dr about the things you mentioned above when I see him again and will post an update on here about the results as soon as I know anything new (for reference for others who may be going through something similar). Scary stuff; sure wish I never smoked, it's a stupid, bad habit, and I can feel it killing/suffocating me and I don't want to die anytime soon. Thanks again for the info/response, I am very grateful you took the time to respond.
Did the PFT & it went bad. Tech was irritated with me as I could not stop coughing at times and had a lot of trouble getting to 6 seconds they wanted. Feel bad because I was trying so hard to not cough and my chest was hurting bad. Have a hard time taking deep breaths and trying to breath out for 6 seconds, felt like I was gonna blow up and/or pass out. Don't know scores, except dlco thing was decreased and tech said did 7% better on other tests after inhaler. CT is a couple wks away, will post what Dr says when all is done.
I just wanted to let you know that I have not had any smokes/nicotine for 17 days now :) Still waiting on my ct results and will update on here once I know more (should be any time now). Thank you again.
I forgot to update this. CT results are in and shows mild bilateral subpleural distal acinar emphysema, a tiny incidental adrenal adenoma, RML and LLL show calcified granulomata, and there are 3 L and 2 R Noncalcified nodules, with largest measuring 5mm. No mediastinal/hilar lymphadenopathy, no interstitial lung disease. Follow up CTs every 6 mo for next 2 years recommended as well as referral to Respirologist/Pulmonologist to determine whether or not to biopsy. Was sent for blood test for alpha-1 deficiency, results not in yet for that. Still quit smoking.
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