can fibrosis be positively diagnosed on plain CXR?

[dan_61]

since i have been a smoker (up until a few months ago), my doctor orders a regular x-ray annually to watch for any issues,  and because i had a solitary pulmonary nodule back in 2010 that was followed for 2 years (thru CT scans) until it disappeared in 2012.  Anyway, the radiology report from the xray 2 weeks ago stated:

"Chronic interstitial fibrosis without acute infiltrate. Heart is normal"
Needless to say, it feels like ive been handed a death sentence and am very worried (only 52 y.o.). My questions:

- since there are numerous subcategories of pulmonary fibrosis all with different pathologies and prognoses, can a radiologist be that certain from a plain x-ray?  
- are other conditions (with better outlooks) ever mistaken for pulmonary fibrosis on x-ray (before ct or biopsy is conducted)?
- what is meant by the term "chronic" in this context?  Not sure how something can be chronic if the last x-rays less than a year before were unremarkable. Also, i had visited a med express last week for my bronchitiis and they also took an x-ray. The doctor there didnt see anything like pneumonia or other abnormality but said if their radiologist  saw anything else  they would call back (which they did not). That fact makes this even a little more baffling.

I do have some crackling (intermittent, not always) in the lungs, but NOT short of breath even while currently having bronchitis with mountains of phlegm and mucus production. My doctor is going to order some pulmonary function tests but not for 6 weeks til im totally over the bronchitiis.  This news has been all consuming and dont know if i can wait that long to see someone again. Any reply you can give would be most helpful, whether optimistic or otherwise. Thank you.

[David Tinkelman, M.D.]

First off, it is extremely unlikely that you have been “handed a death sentence”, especially since there is no notation regarding the severity or extent of the alleged fibrosis and since you have not experienced any new onset shortness of breath.  Also, the fact that the med express X-ray was seemingly normal. It is sometimes possible to make the diagnosis of pulmonary fibrosis on the basis of routine chest X-ray findings but usually not in the earliest stages.  Yes, other transient infectious or allergic lung diseases might be mistaken for fibrosis.

It would be most reasonable for you to ask of your doctor that he/she speak to the radiologist to obtain details and clarification of what exactly was seen to prompt the suggestion of fibrosis.

It is common to refer to such X-ray finds as chronic if they have been present longer than 3 months and have  a certain appearance that is most commonly associated with a chronic condition.

I suspect that this X-ray interpretation may be a false alarm.

Good luck,

[ChrisBSRRT]

Hello, pulmonary fibrosis can better be defined in a CT scan, an anterior-posterior and lateral chest x-ray isn't enough to make a determination of Interstitial Pulmonary Fibrosis. A CT coupled with blood lab panel as well as full pulmonary function tests will make a far better determination in diagnosing this.


I routinely perform pulmonary function tests on patients that have early and chronic IPF/ILD. Pulmonologists will rely heavily on the CT and lung volumes/DLCO (obtained from PFT's) to track the disease and make treatment changes. Once you perform these I think your physician can make a better determination if you do in fact have IPF or not.