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Need Direction w/Diagnosis- PFTs, CT completed
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Need Direction w/Diagnosis- PFTs, CT completed

Need assistance with diagnosis direction, as current care seems fragmented between cardiologist, internist, and pulmonary specialists. Patient has never met with pulmonogist, although his office performed PFTs and sent results to internist.
Patient Info: 65 YO caucasian male- 71 inches, 225 lbs
Symptoms: Shortness of breath and extreme fatigue that is 1) constant, 2) consistent (not dependent on exertion), 3) worsening with time
Onset: Winter 2010
Based on the information below, can anyone provide potential conditions/diseases? It seems the June CT does not confirm the January x-ray finding – perhaps earlier x-ray was picking up on pneumonia? Should we schedule an appointment with the pulmonogist? Should we be concerned about the small liver/lung lesions? Any information would be greatly appreciated!!

December 2009 – Failed stress test. Stent placed for blocked LAD.
December 2009 – gallbladder removed
Winter 2010 – symptoms begin
Jan 2011 – VA physical –Labs normal, but chest x-ray identifies the following:
Findings: nonspecific airspace disease focally at the left base. Mild interstitial prominence left base. Heart and mediastinal borders stable. No acute osseous abnormality. No other masses.
Impression: Interstitial prominence at the lung gases, nonspecific, likely representing a degree of pulmonary fibrosis. Focal confluent opacity left base, possible a localized area of airspace disease within the interstitial changes. Other processes including local pneumonia not excluded.
March 2011  - stress test normal
June 2011 – PFTs and CT performed
SPIROMETRY results:
FVC – Predicted mean: 4.47
Pre-bronchodilator: 2.97/66%
Post-bronchodilator: 3.14/ 70%
FEV1 – Predicted mean 3.58
Pre-bronchodilator: 2.31/65%
Post-bronchodilator: 2.31/ 65%
FEV1/FVC – Predicted mean 80%
Pre-bronchodilator: 78/ 98%
Post-bronchodilator: 74/  94%

LUNG VOLUMES results:
TLC – Predicted mean: 6.86
Pre-bronchodilator: 4.57/ 67%
FRC – Predicted mean 3.79
Pre-bronchodilator: 2.78/  73%
IC – Predicted mean 3.07
Pre-bronchodilator: 1.79/ 58%
ERV – Predicted mean 1.40
Pre-bronchodilator: 1.36/97%
RV – Predicted mean 2.39
Pre-bronchodilator: 1.42/ 59%
RV/TLC– Predicted mean 34%
Pre-bronchodilator: 31% /91%
VC – Predicted mean 4.47
Pre-bronchodilator: 3.15/ 70%
Raw– Predicted mean 1.70
Pre-bronchodilator: .83/49%
sGaw – Predicted mean .26
Pre-bronchodilator: .58/ 223%

DIFFUSION results:
DLCO– Predicted mean 28.73
Pre-bronchodilator: 28.28/98%
DLCO/VA – Predicted mean 4.19%
Pre-bronchodilator: 5.63/ 134%
VA (BTPS)– Predicted mean 6.86
Pre-bronchodilator: 5.02/73%

Notes:
Interpretation – Restrictive
MVV- mildly reduced
Spirometry - No response to bronchodilator
DLCO - Normal
Lung Volume – Decreased (c/w mild restrictive ventilating defeat)
Normal cmH20
Reduced peak flow and short exp. Time – may be effort related

CT CHEST WITHOUT CONTRAST:
6/6/11 Cardiologist reviews below CT explains that below reference to the LAD is likely the stent placed in 12/09
Noncontrast CT chest demonstrates considerable calcification of the LAD which could be hemodynamically significant. Minimal strand attenuation is noted within the lingual involving the pleura probably representing scarring versus atelectasis. No focal infiltrate is identified. Pulmonary nodules are not identified. The lungs are not hyperexpanded and there is no evidence of emphysema.

The visualized portions of the upper abdomen demonstrates features of cholecystectomy. No adrenal lesion is identified. Small low-attenuation lesion is noted within the dome of the liver as well as posteriorly within the right love and these probably represent small cysts although technically are nonspecific.

Impression: Essentially negative noncontrast CT chest except for considerable calcification  of the LAD, which could be hemodynamically significant. Neither mediastinal adenopathy nor infiltrate are evident. The patient is status post cholecystectomy.

A few tiny lesions are noted within the liver which probably represent cysts or hamartomas.
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