Respiratory Disorders Expert Forum
My Pneumonia Scenario
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My Pneumonia Scenario

All started with a persistent slight  fever (99.5-100) and cough that wouldn't go away.  1st doc said that i was probably viral and to let it run its coarse, which i did.  cough still didnt' go away and i started wheezing and coughing more and fever was stil there. another doctoc send me for an  X-ray and it showed a small patch of pneumonia, given levaquin, had a reaction in the middle of the time line to take it, had to stop and start another anti-biotic the next day.  went a week feeling better but cough persisted, did a ton of yard work, the next day felt like crap, ran a fever, some serious coughing, and tightness in my chest went to the ER and X-ray and CT showed it was still there but more specifically it was Reticulnodular opactices in my RLL.  Given IV steroids, IV fluid, some sort of breathing therapy/treatment that seemed to work.  I was also having a bad panic attack too my heart rate was 140-150.  EKG showed sinus tachycardia and it was probably a reaction to my pneumonia and it was just my body's way of reacting.  As soon as someone started to explain something to me my heart rate started to go back down.  recommended me to see a pulmonologist, so i did.  had the appointment, he said everything sounds typical and that my CT scans did show imperfections but he was certainly not worried and said that he strongly feels that I am not a candidate for further study and that all of this was/is pretty typical of recovering from pneumonia.  said to get a follow up CT w/o contrast in 3 months.  I have smoked, but i was a person that smoked maybe 2 packs a month at the heaviest periods and sometimes never a consistent smoker.  How does this scenario sound to you?  Are we on the right path?  What are the chances something is serious here?  
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242587_tn?1355427710
You have provided a lot of good clinical information, but not a time line or duration of illness and that makes interpretation of the data more difficult.  I will assume that all you describe has taken place over a couple weeks and that the X-ray/CT abnormalities have been localized to your right lower lobe (RLL).  If that is correct, the course of your illness is consistent with what is called, Community Acquired Pneumonia (CAP -- pneumonia acquired when not hospitalized).  There are many causes of pneumonia (bacteria, fungi, viruses, chemical or organic irritants) and, even with extensive bacteriologic testing the specific cause is often not determined.  The information you have provided, including the imaging studies (X-ray and CT) provides no clues as to the cause of your pneumonia.

The acute onset of your illness, the apparent response to antibiotics, and the absence of progression of the shadows on X-ray/CT all favor a non-worrisome acute infectious process (CAP).  To respond to your question, the chances of this being “something serious” are remote.  I am impressed that the specialist (Pulmonologist), having all the data and the opportunity to observe and examine you, deemed this to be an uncomplicated, acute process and the progression of the illness to be “typical of recovering from pneumonia”.  

It is important that you should be reevaluated without delay, should any of your clinical symptoms worsen.  It is also important that you have a follow-up examination in a month or two to confirm complete resolution of the “small patch of pneumonia and the reticulo-nodular opacities.  A repeat CT Scan in 3 months might not be necessary if a plain chest X-ray were taken and showed complete clearing, in association with complete clinical recovery.  In that way you could avoid the expense and not inconsiderable additional radiation of the CT Scan.

I believe that you have good reason to be optimistic about complete recovery.

Good luck
9 Comments
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Avatar_m_tn
forgot to note:
He also noted that i had post-nasal drip.  few days after seeming him, i had another one of those nights.  hard to breath, no real wheezing , alburteral inhaler didn't do much.  Called the pulmonologist in the morning.  Gave my flonase and 6 days of steroids to take for my post nasal drip.  he said that my post nasal drip was probably irritating my lungs pretty good and that the slight wheezing i had was coming from my vocal chords.as time has gone on i notice my symptoms mostly at night, such as coughing and a slight tightness in chest.  Feels like theres a lot of stuff in my throat.  Such as this morning.  However when i cough a few times all is clear and im good for the day, besides coughing every now and again to clear my throat.its been about a month now and dare i say it but i am feeling better but still worried a little about these reticulnodular opacties.  I have smoked, but i was a person that smoked maybe 2 packs a month at the heaviest periods and sometimes never a consistent smoker.  How does this scenario sound to you?  Are we on the right path?  What are the chances something is serious here?  
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Avatar_m_tn
oh, also blood tests were run and the only thing that came back irregular was a slight elevation in WBC, which the ER doc said it is most likely due to the pneumonia.
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Avatar_m_tn
wow i need to get my act together....medication was as followed
levaquin (allergic) broke out in hives on my 4th of 7th pill
put on azithromycin 3 pills
albuteral inhaler
fafter ER visit to do the pneumonia being unresolved
prednisone (10 days)
more zithromycin 6 days
after pulmonlogist visit:
more sterioids for my nasal problem
flonase
not my 1st round of pneumonia....had it after a bad motorcycle accident in same lung last year but i was so preoccupied with all my surgeries i forgot when it cleared up....i think a few days to a week and half.
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Avatar_m_tn
thanks a lot doc! and yes this has been over a matter of a few weeks a month at the very most.  i just had an appointment with my primary care doc and he listened and noted that everything sounded clear to him.  However from time to time i still have some wheezing and coughing random is the best description and due to my post nasal drip mostly some irritation at night..  I'm no longer winded when doing activities like i was in the beginning but this cough is annoying.  I guess i just need to give it more time before i expect this wheezing to fully be gone.  and it probably relaxing my thoughts wouldn't hurt either.

i really appreciate your input!
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242587_tn?1355427710
You should not worry about the reticulo-nodular opacities.  Pneumonia can assume a number of different patterns on X-ray/CT, both in the acute phase and during resolution, so this is not an ominous finding.  

The lung “pneumonia” shadows at the time of your accident may or may not have been a sign of infection, but rather a sign of a bruised lung (contusion).  Thus what you have now may not be recurrent pneumonia.  You should discuss this with the pulmonologist.

The rest of the additional information does not change my initial opinion.

One suggestion – given the pneumonia and wheezing associated with it, you should seriously consider quitting smoking.  Given your experience, you may have lungs that are extra sensitive to the harmful effects of cigarette smoke, and by quitting be able to avoid serious lung problems in the future.
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Avatar_m_tn
yeah the word hypersensativity was thrown around by my primary but not by the specialist.  funny you should mention that about quitting smoking, i haven't had one since this happend and find myself not even craving one.  shame it had to go that way but it is what it is, live and learn.

I really appreciate your time.
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Avatar_m_tn
well doc, symptoms didn't get worse i guess but i guess they are persisting.  i was woken up out of a sound sleep last night because of my wheezing, i also had to use my rescue inhaler.  I called specialists this morning, but if i am still not geting anywhere with that doctor I am considereing a 2nd opinion.  I personally feel like i should not be wheezing this long (since end of sept)
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Avatar_m_tn
Pulmonary Function Testing set for next week.  I am starting to get concerned.
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