CT scan results

[ZM1980]

Hi all, I had a CTPA on 27th May and have just seen the results (or radiologists comments) - lung parenchyma generally of increased density, compatible with a semi-expiratory scan acquisition. Minor atelectasis in the lingula. No other significant lung leision or other pathology demonstrated. Normal heart size. No evidence of thromboembolism.

As I understand it, increased density equates to inflammation and atelectasis indicates mild collapse/compression of that part of the lung. No clots.

I have been experiencing left sided lung problems since 2011 (breathlessness on incline, chest tightness, difficulty getting air into left lung) which feel like they have been progressing. Previous X-rays have been normal (or no significant abnormality), recent Spirometry in 2020 indicated mild MEF reversibility/small airways disease, but still normal baseline. I was diagnosed with Asthma in 2011 (no family history or asthma attacks) and Microvascular Angina in 2018.

I have been prescribed various corticosteroid inhalers, which do not seem to help much - most recent one being Fostair Nexthaler.

I am due to speak with my consultant on 28th, but am curious as to what the next steps would be or what questions I should ask in relation to the results (apart from what do they mean/possible causes).

I stopped smoking in 2011, when symptoms started/became noticable.

Thanks in advance!

[Hidden]

With the caveat I’m not remotely medically qualified, I read the report to mean that they believe the density may/could be associated with the image being obtained during an out breath, rather than the inspiratory or holding phase. Whilst expiratory images can be obtained and used, most phases used are inspiratory, so during the in breath. In which case, it reads like they’re saying the density is potentially normal for an image obtained that way, and not necessarily something of relevance to an underlying problem, although my understanding is also that density can sometimes correlate to inflammation. Atelectasis is indeed collapse or potentially fluid in the alveoli, but minor amounts are quite common in people without respiratory issues, and often nothing in particular. Overall, it looks like they didn’t find anything of any real note, which is reassuring, but also frustrating if you have symptoms.

MVD can definitely lead to shortness of breath, and wouldn’t benefit from inhaled meds, so that may be part and parcel of what you’re experiencing. From a respiratory angle, though, if you have no baseline abnormality on spirometry after reversibility, that would support asthma being the most appropriate diagnosis. Asthma doesn’t have to run in families, and it can also occur in later life. With one exception I’ll mention in a sec, the absence of benefit from inhaled corticosteroids would also suggest that there’s nothing majorly obstructive going on, and not much in the way of inflammation, otherwise you would expect to see *some* benefit from trying multiple ICS inhalers, even if only slight: generally speaking, if there’s no underlying inflammation to begin with, they’re not going to help. Do you ever get relief from something like salbutamol?

The exception to the above regarding inflammation/steroid inhalers would be eosinophilic asthma. EA is usually pretty severe, but it often comes on in adults aged 30 to 55 with no history of allergies, and usually has breathlessness as the primary symptom as opposed to wheeze. It also doesn’t respond to corticosteroids the way other forms of asthma do. With EA you would expect to find elevated levels of blood eosinophils, which are routinely checked as part of a bog standard, full blood count, but I thought it was worth a mention. It could also be worth asking the consultant about more general, allergic possibilities/allergy generally, or possibly leukotriene/mast cell driven issues. My daughter has a significant respiratory disease, but in recent years has developed additional, distinct respiratory symptoms as a result of abnormal mast cell activity. In her case, it’s essentially an autoimmune driven response, where her lungs mistakenly believe there’s something invading, so she produces leukotrienes as a defence mechanism, which causes inflammation. She doesn’t have asthma, and doesn’t currently need or respond to inhaled steroids, but persistently wheezes as a result of the mast cell activity in her lungs. The answer for that kind of issue or response is often an oral drug called montelukast, which is primarily used in asthma, particularly where symptoms are allergic (or autoimmune driven) or brought on by exercise. It blocks the effects of leukotrienes on the airways. Could be not even remotely related, but it could be worth having a read/asking some questions around that, maybe?

[ZM1980 in reply to Hidden]

Hello and thank you for your very informative reply. I was quite relived when I read the report did not seem to indicate any major pathology, but was still concerned, as my symptoms have recently worsened - although this could be more of Cardiological origin, as the chest tightness and palpitations have increased in severity with more strenuous exercise. On the other hand, I have been experiencing unusual chest pain (possibly musculoskeletal), shortness of breath and breathlessness when talking. I am taking Nicorandil for the Microvascular Angina, although I'm not sure how effective this is (have an appointment with GP on Monday and due to speak to Cardiologist in July).

With the Spirometry results, there was improvement in the MEF post Bronchodilation - I suppose this would fit with the small airways disease diagnosis. I was prescribed Salbutomal alongside ICS inhalers, but in the past did not notice a difference after using this - might try again, given the more recent results.

I've heard of Montelukast, but haven't really looked into/researched it. It's good that your daughter benefits from taking it and I'm sure you being well informed helps with her care.

Thanks for the suggestion re allergies etc - this is something I will definitely mention to my consultant.