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Monday, March 10, 2014
I recently was assigned the diagnosis of Pulmonary Fibrosis by my cardiologist after I completed a DLco test that showed 60% of normal oxygen diffusion. I have had a coronary nuclear imaging study that showed lower left sided hypokinesis, a coronary angiogram that was normal with no blockages, a CAT scan that showed bibasilar dependent atelectasis, an abnormal ABG showing alkalosis, and a Holter Monitor and King of Hearts Monitors which showed inappropriate sinus tachycardia.
I have not had an appointment with a pulmonologist yet. I am wondering if there are further tests my doctors will be ordering to define the cause of the Pulmonary Fibrosis?
In this situation, we would normally start with pulmonary function tests (spirometry, lung volumes, and diffusing capacity) plus a 6-minute walk test. It sounds like you may have had some of these already.
Atelectasis on a chest CT does not necessarily mean that there is pulmonary fibrosis present, and we generally check a high resolution chest CT with supine and prone images. This will require laying on the back and then on the stomach during the CT scan. If the CT abnormalities are due to atelectasis, then they typically improve when laying on the stomach during the CT. In addition, the pulmonologist will likely do additional testing for other causes of fibrosis (such as lupus and rheumatoid arthritis) depending on your history and physical examination.
James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University