chest and back pain

[poornim]

hi

    My name is Poornima and I am 26 yrs old.  Last year i went on with the ICD operation in my left side of lungs as doctors found that I was suffering from pneumothorax.  I am not an asthmatic or a cold prone person since that ICD operation.  Even doctors couldn't predict abt why I got that pneumothorax in this age that too for a female.  But my father underwent the same ICD operation 2 years before.  But doctors say that its not a genetic oriented disease.  

    My question is , now i am in Finland along with my husband, will stay till june.  now for the past 1 week I have a severe back and arm pain on my right side. But to my knowledge i don't feel any breathing problem.  But still the pain persist i tried by applied some pain relief spray thinking it could be  a muscular pain.  we'll return back to india in two weeks.  Is it the same problem which i had previously or something other like gastric and muscular problems.  pls suggest me something as i am really scared abt this

[vedadhar]

  List of Lab tests for CF
•     Pilocarpine iontophoresis (“sweat test”): diagnostic of cystic fibrosis in children if sweat chloride is >60 mmol/L (>80 mmol/L in adults) on two separate tests on consecutive days.
   •     DNA testing may be useful for confirming the diagnosis and providing genetic information for family members  
   •     Sputum C&S and Gram stain (frequent bacterial infections with Staphylococcus aureus, Pseudomonas aeruginosa[most common virulent respiratory pathogen], Haemophilus influenzae)  
   •     Low albumin level, increased 72-hr fecal fat excretion  
   •     Pulse oximetry or ABGs: hypoxemia  
   •     Pulmonary function studies-decreased TLC, forced vital capacity, pulmonary diffusing capacity

IMAGING STUDIES

   •     Chest x-ray: may reveal focal atelectasis, peribronchial cuffing, bronchiectasis, increased interstitial markings, hyperinflation
   •     High-resolution chest CT scan: bronchial wall thickening, cystic lesions, ring shadows (bronchiectasis)  

[vedadhar]

Its very good to know that you dont have tuberculosis.If you have to talk to your doc about the chances for you be a victim of Cystic fibrosis(CF) then the following things should be kept in mind.The symptoms of CF include failure to thrive,increased anterior and posterior chest expansion,clubbing,cough,abdominal distension,greasy and smelly feces.It could be presented in many organ systems of the body like respiratory and digestive causing general symptoms in relations to the other system dependent.Recurrent pneumonia and asthma can sometimes be presented with same symptoms but their diagnosis is mainly based on lab tests.If CF has be be confirmed then you must undergo positive quantitative pilocarpine iontophoresis test when  documented CF in a sibling or first cousin or close relations.Talk to your doctor and keep me updated.

[poornim]

I am grateful and thanku for ur valuable and informative reply.  As u said one of the reason for pneumothorax is tuberculosis, last time they tested my sputum confirmed that I don't have tuberculosis.  But still my CT scan report says (after ICD) even after expansion of lungs there still persist some small cysts size seems to be very very smal. At that time we don't have an ideas about cystic fibrosis.  I must clear that factor from the doctor.  I came to know only from ur answer.  thanks for that.

[vedadhar]

After getting into the details you gave me,Pneumothorax can be of many reasons like COPD, bronchogenic carcinoma, sarcoidiasis,tuberculosis,cystic fibrosis (congenital).As you are from India which is a place for epidemic tuberculosis infection.So first get it ruled out by Tuberculin test which may be done efficiently in India.
If there are no other serious symptoms,I think there is nothing to be worried much.Meet a pulmonologist who is expert in lung diseases.Your arm pain could be due to the previous surgery and also may be due to recurrence of the symptoms of pneumothorax.
Symptoms of pneumothorax includes tachycardia,dyspnea,reduced tactile fremitus.So meet the physician and let all the General and specific thoracic examination done with all required Lab tests done.
Its hard to comment beyond this stage until you come up with your history of previous health problems.Keep me updated with other details.Ill certainly help you.