Hi Dr. Aren,
Received the official report from the CT (had much more information than my doctor's first brief email to me).
Here is the official reading. (My questions are at the bottom)
The apical "fibrotic change/ground glass" findings in the upper lungs have not changed in the last 10-11 months. The more they stay the same, the more scarring from old infection is likely. If they change, we will begin to think about an active infection.
If you have not had a PPD, tuberculosis skin test in the last year or two, you should, as tuberculosis can lie dormant in the upper lobes of the lungs for years. The test is ordered, and is available and at the Birch building injection clinic. Monday, Tuesday, Wednesday, Friday I think, 9-5. No tests on Thursday. You may want to call ahead for better timing.
Sincerely, XXXXX XXXXX MD
CHEST CT NONCONTRAST
** HISTORY **:
Followup left lung nodule
Comparison: 4/3/2012, 1/24/2012, 12/1/2011
** FINDINGS **:
Contiguous collimated transaxial slices were obtained in helical
mode from lung apices to level of adrenal glands with no IV
Previously described 4 mm nodule in the lingula is unchanged. No
new pulmonary nodules identified. Allowing for differences in
technique, previously described nonspecific biapical pleural
parenchymal fibrotic change/groundglass opacities are not
significantly changed compared to prior chest CTs dating to
1/24/2012, possibly representing inflammatory or infectious
process. There is no new focal consolidation. There is no pleural
Allowing for noncontrast technique, heart and great vessels appear
grossly unremarkable, unchanged from prior studies. There is no
pathologically enlarged mediastinal lymphadenopathy. Limited
views of the upper abdomen are grossly unremarkable, allowing for
limitations of noncontrast technique.
No suspicious lytic or blastic osseous lesions identified.
** IMPRESSION **:
Unchanged appearance of 4 mm nodule in the lingula. According to
Fleischner Society guidelines, in a smoker high risk patient,
continued followup in 6-12 months would be recommended.
Allowing for differences in technique, previously described
nonspecific biapical pleural parenchymal fibrotic
change/groundglass opacities are not significantly changed
compared to prior chest CTs dating to 1/24/2012, possibly
representing inflammatory or infectious process. Attention to
this area on followup is recommended.
KENNY C LAI M.D.
My questions: I understand the part about "things look unchanged"....but I guess I could use a clarification on the possible infection issue.
1) If old infection, does that mean it doesn't have to be treated?
2) If new infection, are they only referring to TB? ...or possible some other kind of infection?
3) Your overall opinion, do you agree that the 6 - 12 month follow-up is appropriate? (when they say Follow-up, I assume they mean another CT?)
Thank you very much in advance Dr. Aren. (Will rate upon receiving your response).