Pneumonia/Lung Scarring

[LEB32822]

Two months ago I was diagnosed with Pneumonia and Pleurisy of the Right Lung which was not found in a chest X-Ray, but in a CT Scan. I was given a Z-Pack for 5 days. The pain in my upper right quadrant went away, but on the 3rd day of taking the Z-Pack, I developled a profound cough and shortness of breath was persistant. Once the Z-pack was finished, my doctor prescribed Levaquin, but after 2 doses I had a rapid heart beat. He then told me to discontinue taking it. I have had several tests done including a Full PFT with dialator which shows restrictions in the airway. I recently had another CT Scan which reported scarring in both the upper Left lobe and lower right of the lungs. I have been taking Advir 2x daily for the last 2 weeks and the coughing is now minimized, some days worse than others. I cough mostly when I am at work. My pulmonologist says that he is not sure how to diagnose me b/c I do not have asthmatic symptoms and he thinks I may be developing Restrictive Airway Disease. That sounds a bit vague to me. He has requested a V-Q Scan and a Methacholine test in addition to all the testing I have had done. I have read that Methacholine tests are done to determine Asthma. If I do not have asthmatic symptoms, I am not sure why he is requesting that test. Also, if I had Pneumonia and Pleurisy in the Right Lung, why or how did the left lung get damaged or have scarring? I am still having shortness of breath and rapid pulse rate (111 beats per min). My Pulmonologist doesn't seem very confident in what he is doing. I am very concerned. When I make my bed I become winded, if I walk up a flight of stairs I become winded also, simple activities causes me to become short of breath. I have never smoked and I am only about 15 lbs over weight, 10lbs was gained in the last month. Please help...

[National Jewish Health]

There is a possibility that the diagnosis of pneumonia, two months ago, was incorrect.  From your description, the shortness of breath that you have experienced is out of proportion to the pneumonia (not even evident on chest X-ray and only on CT Scan.)  It is more likely that your being so easily winded, “if I walk up a flight of stairs” would be caused by a disease other than pneumonia, with or without pleurisy.  The more likely cause of your abnormal CT scan, pleurisy and severe shortness of breath would be recurrent (possibly including the present) clots to the lungs (pulmonary emboli) or heart disease, including a condition called constrictive pericarditis.  This latter could be caused by a virus and the same virus could have caused your pleurisy.

Again, the severity of shortness of breath is unlikely to be explained by asthma without spirometry findings of airflow obstruction or by restrictive lung disease without more CT findings, the alleged scarring notwithstanding.  The scarring is probably a “red herring.”Your doctors should consider ordering an Echocardiogram and a Spiral CT Scan, with specific attention to the blood vessels of your lungs.  .

You should discuss the above with your pulmonologist and, if he/she remains puzzled, you should request a second opinion.

Good luck