What does this mean

[madcarly]

My 2nd lung ct in six weeks showed the following: There is mediastinal lymphadenopathy. Largest lymph node in the paratracheal and precarinal location measuring 1.4cm X 1.5cm. This node has enlarged in size since study of 4/4/08 when it measured approx. 1cm in diameter. There is mild left hilar lymphadenopathy noted similar to the study of 4/4/08.The lung parenchyma demonstrates emphysematous changes involving the upper lobes similar to 4/4/08. Howver, since previous exam there have been development of patchy ground glass infiltrates w/upper lobe predominance. There is no pleural effusion,no pneumothorax. The etiology of the bilateral multifocal ground glass infiltrates in uncertain.These could represent infectious etiology, such as viral infection or opportunistic infection. Since these are largely peripheral, other possibility include etiology such as Boop,bronchiolitis obliterans organizing pneumonia. Follow-up is recommended.

IMPRESSION:Interval development of bilateral multifocal gound glass infiltrates w/upper lobe predominance. Diagnostic consideration include infection such as viral organism or opportunistics infections if the patient is immune compromised/chemotherapy medication versus other etiologies such as eosinophilic pnewmonia or BOOP. Please correlate w/ clinical scenario. Follow up is recommended.

I also had a broncoscopy performed that was negative for any fungal or viral infection. Increased intraalveolar pigmented macrophages are seen. Benign lung parenchyma w/ hemmorrhage and realatively prominent intraalveolar pigmented macrophages.Broncial Brushing: Benign bronchial epithelial cells are present.

What does all this mean?  Should I ask for a repeat CT? The last CT was done 5/23/08 and the broncoscopy was done 06/02/08. I see the lung doctor every month and my pft are not improved. I still have chest and back pain, shortness of breath and cough. I have asked my doctor about the nodule increasing, he says it is not big enough yest where the insurance would pay for any more testing like a different type of biopsy. What questions should I ask?

[cath711]

i have just had an mri scan which showed patchy changes in my lungs. i dont understnad what it means. ive had a really bad cold few weeks ago. the last few days ive had alot of pain in my joints. does anyone no what it it

[HeinrikMD]

Hi,

The lung tends to have a limited way in responding to any stressor, be it a disease or a reaction to the drug. If it is a question of the nodes, it seems to be more likely due to the rheumatoid arthritis than the methotrexate, however since you have other findings which may mean injury along the interstices (supporting architecture of the lung), then this would implicate the drug. A therapeutic trial to see if the lungs would also improve seem like a reasonable thing to do. Stay positive.  

[madcarly]

Thank you so much. I am just home from another appointment. They presume it is my rheumatoid arthritis, like rheumatoid nodules from what they are saying now. My R.A. doctor says my R.A. is quite severe now and we need to treat that and maybe the lungs will improve. I was on methothrexate and enbrel for a while, they don't know what caused this lung problem; the drugs or the R.A. So we are just in a holding pattern.

[HeinrikMD]

Hi,

One of the things you could consider is to look into your personal and occupational history, looking into any significant exposure that may lead to the current condition of the lung. The goal would be to avoid the exposure if possible. One thing to discuss is whether this is deemed a chronic problem or not, so you would know what to expect with the monitoring, is there an expectation of complete resolution?, or is the goal merely stability (meaning looks the same, but not apparently getting worse).  You could also discuss the role of steroid therapy. Stay positive.