CT Scan - What do I do???

[NishaTom]

Hi

29F,non smoker,quite healthy.In Aug 02,I had some chest pains/ dizziness after a diff. delivery (twins).I went to the ER & they did a chest X ray.It showed a shadow in my trachea and I was advised to have further scans.I had a CT scan of neck/chest WO contrast done & the report reads "diffuse fibro fatty infiltration of mediastinal fat planes without infiltration of vascular structures or trachea-possiblity of old mediastinitis with no abnormality in the lungs" This was in India & the dr. & radiologist both assured me it was nothing to worry about and that it was just some kinda scar fm a prev. infection. Also my chest pains disappeared. Last mth, I went for my annual checkup & all this came up again & the dr. here wanted me to repeat the CT scan as it was done in India. So I again had a CT chest WO contrast (since I am nursing) and the results read:

No evidence of tracheal abnormality.
Intermediate opacity within mediastinum likely related to residual thymus.
Tiny area of opacity in right middle lobe likely post infectious/inflammatory.

My dr. says she's not worried about the first two but she's concerned about the last one & she again wants me to go for another CT chest scan with contrast. I am concerned that I've already had two CT scans (the radiation of which is equiv. to 1000 Xrays) and I am not sure if I really  need to subject  myself to further radiation. What should I do? Are my results really concerning? What do they mean?I thought post infectious/inflammatory means its like a scar tissue fm a prev. infection. Pls suggest further course of action.TX

[National Jewish]

The CT scan was the best test for your trachea and, you should not have any further concerns about it.  Likewise the mediastinal changes are not anything to worry about or even follow-up.  In a 29 year old non-smoker, the area of opacity in your right middle lobe is almost certainly post-infectious.  Such opacities are common in the middle lobe.  Given this, I see no urgency to repeat the CT Scan and, actually, might never repeat it.

This is something that could be followed by chest X-ray.  If it is too small to be seen on Chest X-ray, the odds of its being a malignancy, which are already very low, would be even lower.  Again in a person this young, with no history of smoking, any lesion equal to or less than one cm. is almost always benign.

This is the opinion of one pulmonologist who has not seen the X-ray and scans.  Do not decide to ignore the advice of your local physician based only on my advice.  My recommendation is that you have a 2nd opinion from another pulmonologist, before agreeing to any more X-rays or scans.

[Ellis7]

Since you don't have symptoms, I would be inclined to wait a few months; say 4-6 mo, before having another CT scan. Then you could see if any change in size.
Alternatively you could get a 2nd opinion from another doctor on the need for it at this time; or ask for referral to a pulmonologist for his opinion. The radiologist report doesn't seem to recommend another CT scan now.