Worried about chest x-ray report

[DRGPS51]

I went to ER for heart palpitations/shortness of breath and among heart tests, they did a chest x-ray, which came back with "somewhat nodular bipacial pleural-parenchymal scarring" and a recommendation to repeat the x-ray in 6 months. I have no idea what this could be. I'm 69, a never smoker, vaper etc. in good health. All my blood labs were normal, normal BP & oxygen at 96.

I had a PE 3 years ago with a follow up CT scan two weeks later that showed no scarring and the clot was gone.

Can someone shed light on what this result means and is it serious? I see my primary doc (I'm in the US) on Tuesday, but I'm so anxious.

[Biker88]

Almost any chest infection will result in leaving signs of scarring in the lungs. I suspect there will be very few people of our age to have totally clear lung X-rays, if it was something to worry about I would have thought the ER would have referred you to a specialist clinic straight away instead of recommending a repeat X-ray in six months.

[DRGPS51 in reply to Biker88]

Thank you. Your comment gives me a reason to be hopeful & less anxious until Tuesday.

[Bkin]

After, lung infection, pneumonia, lung inflammation there are indications that certain areas of lung are not as they should be, the reason for checking up again in 3 or 6 months is to make sure there are no further traces that indicate a problem remains.

Your CT scan showed no scarring and clot was gone which indicates your lungs healed well and there is no problem.

I would say your follow up xray is just routine to be sure all remains well.

I wouldn't be worrying about a routine follow up check, these are in themselves routine like having a dental check although I understand this can cause anxiety too but its soon passes and all these routine check are to help us maintain good health.

Best wishes for your pending follow up Xray.

to understand the situation better you can read about Pleural thickening here:

respiratory-research.biomed...

[Hidden in reply to Bkin]

I think the OP’s concern is the original CT post PE showed no scarring, but they now have scarring found on x-ray. This scarring may well have developed in the 3 years since their CT scan, so my interpretation is they’ll want the repeat x-ray to see if there are any further changes over time.

[DRGPS51 in reply to Bkin]

Thank you.

[Hidden]

Scarring within the lungs can arise for lots of different reasons, ranging from a normal chest infection, or historical exposure to certain substances like asbestos, through to far more worrying things. Any process involving inflammation can result in scarring, and the biapical bit just means it was present at the top of both lungs, rather than one.

The interesting thing about lung changes on x-ray is that they can take time to disappear even after the underlying problem has been dealt with. For example, in someone that’s had quite a severe case of pneumonia, it can sometimes take 2 or 3 months for an x-ray to return to normal, and after any lung infection or issue, there can be some permanent changes that will continue to show even if they’re not of concern, and particularly as we get older. The purpose of a repeat x-ray would be to see if there are any changes compared to the one you’ve just had, either for better or for worse, and given the US health provision is profit driven, I would take some reassurance from the fact they’re saying repeat the x-ray in 6 months: if they thought it was anything particularly nefarious, I have no doubt they would have recommended referral to a pulmonary specialist for evaluation now, assuming you’re insured. See what your primary doc has to say on Tuesday, but if they also say don’t worry, repeat the x-ray in 6 months, hopefully that would be reassuring for you. Your primary doc might also suggest getting spirometry done just to be on the safe side, but if that’s also normal, that would be another good sign. What I would say, though, is that if it’s agreed to wait 6 months for another x-ray, if during that time you develop any respiratory symptoms like a persistent cough or shortness of breath, it would be best to get that checked out before the 6 months is up.

[DRGPS51 in reply to Hidden]

Thank you for this explanation, which is very helpful. I need to add that when I went to the ER, it was because after getting the 2nd Pfizer shot, I experienced both shortness of breath and heart palpitations. I had an EKG, Echocardiogram & blood work in addition to the chest x-ray. I was diagnosed with "ventricular bigeminy" (ectopics) along with normal blood work, BP and oxygen levels. The ER doc thought the bigeminy might go away on its own, but so far, it hasn't. The ER team never said a word to me about the chest x-ray results, but when I pulled up all my test results online, I saw it and was concerned. Now, hearing you say if I get a persistent cough or shortness of breath, those are symptoms that may be meaningful & worth noting regarding the lungs, it gives me pause. I do have a cough, which I thought was related to allergies and comes and goes. I'll be sure to mention to my primary doc about my cough, along with the SOB. Hopefully, he does request spirometry testing now, so I can be more reassured. Hoping the bigeminy & SOB is not associated with the lung scarring. Appreciate your detailed explanation and good wishes. I know at this age/stage of life "things" can happen suddenly with our health. I just hope I'm not facing anything terrible. I waited too long to travel!

[Hidden in reply to DRGPS51]

I belong to the British heart foundation page as I have both premature ventricular and atrial contractions, along with an arrhythmia triggered by atrial ectopics (supraventricular tachycardia), and there have been relatively frequent reports of palpitations/arrhythmia following covid vaccination. As far as I’m aware, it’s usually settled again within a few days, however you can have ectopics without any awareness of them occurring, so it’s possible that you’ve had the bigeminy for a while and just not been aware. I had the Pfizer at the end of Jan and had anaphylaxis, but thankfully no additional side effects like palpitations to add insult to injury.

I’m not remotely medically qualified, but what I do know is that it’s always a good idea to discuss any ongoing concerns with a doctor, however minor we think they may be. As with many situations in life, minor things may be nothing, but sometimes they can turn into big things if left unattended, like the odd noise that occasionally comes from the car before one day it just kaputs completely. If you tell them about the x-ray report, along with the cough and sob, even if it’s fairly intermittent, the worst thing that can happen is they suggest more tests to establish if there is anything underlying, and I’ve always personally felt a diagnosis is much better than not knowing and having a question mark about whether there is anything going on lurking in the back of your mind. The worst thing you can tell me medically is definitely ‘I don’t know’! Spirometry is a 10 minute job and gives you some very useful information to work from. If there is anything else going on, it’s also a solid benchmark for monitoring most conditions going forward.

Let us know how you get on, and good luck.

[DRGPS51 in reply to Hidden]

I'm sorry you had anaphylaxis after your vaccine shot! I wonder if it's mostly a Pfizer thing with these reactions. I also did some sleuthing of prior test results and sure enough, "bipacial scarring" was noted on both my x-ray and CT scan in 2018. So, my doc will have a comparison at least. Thanks again for all the helpful info and good wishes.