COPD (Chronic Obstructive Pulmonary Disease)

Reliability of CT chest 07/23/2009

Question:

I am 44 yrs old- never have smoked.I have tested negative for the type of emphysema caused by a enzyme deficiency.I have lots of shortness of breath with exertion and air hunger at night that hinders my sleep due to having to sit up to breathe. Because of a declining dlco (now is 63%) and falling VC, my pulmo ordered a ct chest. I have restrictive lung disease with resp. muscle weakness due to a myopathy. My ct chest showed emphysema,bronchial wall thickening and nodules present. My dr. thinks the nodules are most likely mucus plugs. The radiologist suggested a repeat in 3 mos but my dr wants to repeat spirometry and dlco in 6 mos. On a recent chest film, it also showed hyperinflated lungs and flattened diaphragm. Also, to further complicate things, my RV function is also declining and my doc thinks I may be developing PH. He suggested that if my muga scan, to be done this week, shows further decline that he will proceed with a rt heart cath.LV function is good although the left venticle is stiff and shows decreased compliance. I have a documented hypoventilation and elevated CO2 during sleep but am unable to tolerate cpap. 

My questions are: Is there a coorelation with the emphysema findings and RV function? Is the ct a reliable diagnostic tool for emphysema?

Answer:

There may be some correlation between the emphysema and the PH in your case. However, the hypoventilation may be the more likely contributor to your PH. The chest CT is generally a very good test to detect emphysema. The CT findings of emphysema do not alway correlate with clinical symptoms, though.

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Response by:

Mahasti Rittinger, RRT Clinical Program Manager of Pulmonary, Allergy, Critical Care & Sleep College of Medicine The Ohio State University

Phillip T Diaz, MD Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine College of Medicine The Ohio State University