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Lung diseases

Lung Scarring-2

06/28/2010

Question:

I went to the doctor because I had an occasional sound at the end of a deep inspiration that I suspected might be coming up the airways from deeper in the lung. Otherwise I was symptom free and can run easily 3x per week. It was the persistence of this sound (not a wheeze)from Christmas to May that made me wonder if something was brewing. By stethoscope the lungs were declared clear. I asked for an X-ray and the result was lower left consolidation. After six weeks I had another X-ray and the verdict was unchanged/no further treatment required. This appears to be scarring therefore and it was a complete surprise. Is 6wks a sufficiently long period to assess its stability? Thank you.

Answer:

As most questions about a picture (x-ray in this case), detailed information or opinion is not possible without review of the film. I will discuss however some general topics which are likely relevant to the submitted question.

The reporting of lower left consolidation is non-specific, lacking important clarification but apparently corresponding to abnormalities heard during an exam performed by a physician. The lacking information raises the following questions in my mind, which are important in evaluating many chest x-ray abnormalities.
1) What is the extent of the area involved? (Tiny or large?)
2) What is the character of the area involved? Consolidation implies a very dense or filled in area and it is unclear if this is the case.
3) Are there any associated findings?
4) Does this area possess any identifiable characteristics that identify the cause of the abnormality with reasonable certainty?

The question specifically below was relating to scarring and stability and the answer to these is: It depends. What appears troubling to the submitter is a persistence of symptoms and uncertainty of cause. Both of these factors should be discussed with your physician to a satisfactory resolution and are very reasonable concerns. Six weeks under some circumstances may be adequate for a defined process to provide reassurance. However six weeks may often be inadequate when undefined or uncertain processes are being evaluated. It is always best to discuss the above questions with your physician. It is important to evaluate or follow unclear processes to resolution or acceptable resolution of uncertainty. If additional concerns remain, consultation with a (or another) pulmonary specialist is reasonable.

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Response by:

Robert  Schilz, DO, PhD Robert Schilz, DO, PhD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University