Hyperlucency/Bulla (xray/ct scan)

[diagnoseme]

I had a chest xray done about six mths ago that said "hyperlucency in right apex, could be related to bulla".  No one at the ER (where I had it done) mentioned this.  I got my records recently for personal use and saw this in there.  I was outraged that no one mentioned this because it sounds scary.  I have never smoked and don't cough.  Does anyone know what this is?  I told two diff. heart doctors about it recently and one said it's probably nothing, don't worry and have another xray done in six mths and another heard doctor said for me to get a chest ct w/ contrast.  I would get a ct done but have had 4-5 done in the past (for sinuses, neck and abdomen/pelvis) from 2001 to 2005.  I also recently had heart ablation/fluroscopy two months ago and have had several chest x-rays in the past and am afraid to get more due to radiation exposure.  I was unaware of this in the past but have recently done research.  Can anyone help?  I am a 32 yr old female.  Thanks.

[opinmin]

First, so sorry to hear something else abnormal.  

Secondly, discuss with your cardiologist about doing a possible ICD placement if you do not want to go through another ablation.  

Thirdy, the 2mm lung nodule needs to followed up definitely; would not wait one year though given your family history of cancer.  Perhaps you could follow up with a Pulmonologist for his/her opinion.  It is small for now.  

Fourthly, hang in there.  

[caregiver222]

Neither an x-ray with contrast nor  a CT are appropriate. An MRI provides a less dangerous and more clearly defined image. I would be overly concerned about the radiation level. Every unnecessary x-ray in a woman of child bearing age represents a danger that should be weighed against the benefits. CT scans are essentially obsolete and should not be considered, except in an emergency. If you needed the x-ray that would be one thing. An x-ray simply is fundamentally useless to properly diagnose your problem. An MRI is the way to go. As far as "putting off pregancy" there isn't enough information to make that decision. I would not be overly concerned about the lung nodule.

[diagnoseme]

Sorry about the confusion with the cardiologists.  It's a long story...  but I went to the ER in Apr 09 with SVT.  I had a chest xray that showed hyperlucency in right lung could be related to bulla; however, I didn't find out about this until a month ago when I got a copy of my medical records.  I got a cardiologist during the summer who did an ablation in Sep 09.  Since I didn't know about the xray until last  month, I wasn't able to mention it to my cardiologist until then.  He said it's probably nothing and to get another xray in six months.  He put me on potassium after the ablation didn't work but no other medications.  He suggested another ablation.

Then a few weeks ago I went to my primary care doctor because I wasn't feeling well and she did an EKG because I told her I was having right sided chest pain when I move or breath out deep.  The results of the EKG were abnormal and she referred me to another cardiologist on the spot even though I told her I already had a cardiologist.  She didn't think he was doing a good job by the ablation not working and only putting me on potassium, so I followed her advice and went to another cardiologist the same day.  So it wasn't my intention to get another cardiologist although I was disappointed about the ablation not working.  Anyway, that's how I got another cardiologist.  I've only seen the second cardiologist once and he put my on Toprol 25mg and told me to continue the potassium and see how that does.  (I've been on toprol for a week and it hasn't worked yet.  Still have short runs of SVT and continuous PVC's.)

Also yesterday I had a CT w/contrast of my chest.  That was my original concern in this forum.  The second cardiologist ordered this after I showed him the chest xray report in Apr 09.  He suggested the CT because of the xray and to look at my heart muscle.  He called today and said that my heart and the arteries surrounding it looked good but there was a 2mm lung nodule in my middle right lung.  Now something else to be concerned about!  He told me that it was too small to do further testing except to get another CT in a year to see if it has grown.  He said that he was 99% sure that it was benign but still cause for concern.

[opinmin]

First, since you are dealing with alot right now with your own health I would recommend putting getting pregnant on hold until you figure out what is going on with you.  Now is just not the time.

Secondly, I have heard of patients having two heart ablations.  I have never read or heard any major issues with radiation exposure after having the ablations.  Has the physician discussed with you about the possibility of implanting a ICD device?  I am assuming your SVT has not responded to medication at all.  Talk with the cardiologist about other options.  I didn't understand the situation with the cardiologists.  Did you get sent to the second cardiologist because of the SVT and/or the abnormal chest x-ray?  

Thirdly, yes, get the CT of the chest with CONSTRAST to rule out any major problem.  

[diagnoseme]

I actually didn't even know that the chest xray I had in Apr 09 showed a bulla thing was there until after I got my ablation in Sep 09.  I just went to get a copy of my medical records about a month ago and noticed the chest xray report in there.  I was very upset about it because no one mentioned this to me.  And even after I mentioned this to the heart dr who did my ablation, he didn't seem to think it was anything and just recommended me to get another chest xray in Apr 10 due to the radiation I got from the fluoroscopy/ablation.  Just this past week, my primary care doctor referred me to another heart doctor for another opinion.  I mentioned the chest xray in Apr 09 to him and he's the one who recommended the chest ct over another xray.  Do you think this is wise to go ahead with the chest ct?

Also what have you heard about heart ablations and radiation from those?  I have had SVT and irregular heart rate for many years.  Because I was trying to get prenant and hoping to not have to deal with my fast and irregular heart rate while pregant, my first heart dr suggested ablation.  He said it was a success but it came back a month later, feels worse now than ever.  He even wanted to go in for more work and do another ablation after I told him it came back but I said no, not now anyway.  Any thoughts?

[opinmin]

I can't believe you didn't have another chest x-ray prior to your heart ablation.  I would not be overly concerned with the radiation level; you receive such a minute amount of it.  

Secondly, get another CT scan if you care about your future.  You definitely want to make sure you are HEALTHY prior to trying to conceive.  The family history of cancer and having a heart ablation are more significance versus the 4-5 CT scans and the chest x-ray.

[diagnoseme]

The chest xray I had done six mths ago said "hyperlucency in right apex of lung, could be related to a bulla".  I haven't had a chest xray since then.  My main concern is the amount of radiation I've been exposed to in the last several years.  As previously mentioned, I've had 4-5 ct scans, along with several xrays and am concerned that the amount of radiation I've had already at age 32 will cause cancer and/or cause problems in my possible future children, as we have been trying to get pregnant.  I have already scheduled, cancelled and re-scheduled the chest cta with contrast but am still debating on this.  My dad did from colon cancer four yrs ago and because of that history and the radiation I've been exposed to, I'm concerned.  I never thought about this in the past but since we have been trying to get pregnant, I'm really concerned for me and future kids.  Not sure what to do?

[opinmin]

I would recommend going with the latter physician's advice; a chest CT with contrast.  CT will give a better view vs an xray.  The other CTs you had done are old and are not focused on the chest.  Curious, what did the last chest xray show?