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COPD (Chronic Obstructive Pulmonary Disease)

CT Chest Findings

08/26/2010

Question:

I am 45 yrs old. I have a mito. myopathy with the resp. muscle weakness. I had a CT chest last year that showed an enlarged PA and a nodule . So my pulmo. had it repeated in June. My PFT`s show a restrictive process with decreased DLCO (60`s) but have stayed stable. My MIP and MEP are very low ( 18 % & 21%). I had a RHC that was nl. Findings: Left infrahilar calcified lymph node is seen. No pericardial or pleural effusion. Main PA measures 3.6 cm. Lungs are hyperinflated. mild emphysematous changes are seen. No pneumothorax. Mild bronchial wall thickening. Again identified is a tubular/nodular opacity in the medial aspect of the LUL just superior to the hilum. An additional curvilinear tubular shaped opacity is evident in the LUL just superolateral to this lesion. Subsegmental atelectasis along the left major fissure. Calcified lymph node is seen within the LUL/ No infiltate. Additional 4 mm rounded opacity is identified in the posterior aspect of the LUL. Impression: 1. Likely scattered AVM`s of the LUL. Further evaluation with CTA of the chest is recommended. 2. Pulmonary nodule in LUL. F/u CT in 12 mos is recommended.

Now on last year`s CT , there were no AVM`s. What is a CTA? My dr, of course, has not communicated to me that this was recommended. Are AVMs dangerous in the lungs? I know people have them in their colon`s etc and they can cause bleeding. Never heard of them in the lungs. The nodule concerns me somewhat. Also even though my RHC was nl, the PA is enlarged. What are some other causes as to why this would be enlarged? The subsegmental atelectasis was present last year as well. I was told this was due to the muscle weakness. What causes bronchial wall thickening? Thanks for your time and help.

Answer:

AVMs can cause bleeding in the lungs and also contribute to low blood oxygen levels.  However, a diagnosis of AVM can be difficult on a standard chest CT.  A CTA is a CT angiogram.  This study would involve the injection of contrast material into the veins to better evaluate the blood vessels in the lungs.  Such a study could help confirm or rule out AVMs.  Subsegmental atelectasis could be caused by respiratory muscle weakness.  The significance of an enlarged PA with a normal RHC is unclear.  Bronchial wall thickening can be caused by a number of conditions, including previous pneumonia, asthma or bronchitis.
 

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Response by:

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