Question: Hello,
After my PCP visit I'm trying to assess my approximate probability of pulmonary fibrosis or something more serious than infection. I live in the midwest(USA) where there are alot of histoplasmosis and I mow and rake leaves in my yard(wooded) where there are lots of birds.I just finished reading about pulmonary fibrosis and the relationship to fungal exposure which I thinh has been ongoing for about 20 years. Can you estimate the probability of PF or any other serious diseases based on my ct? I'm trying to get a % if possible. I'm otherwise healthy, quit smoking 33 years ago(after 34 pack years) and am physically very active on a daily basis Had a normal cbc and complete blood count 7 weeks ago. Thanks for your expertise and time. A rough percentage would be very nice. XXXXXXX XXXXXXX

Hello,
After my PCP visit I'm trying to assess my approximate probability of pulmonary fibrosis or something more serious than infection. I live in the midwest(USA) where there are alot of histoplasmosis and I mow and rake leaves in my yard(wooded) where there are lots of birds.I just finished reading about pulmonary fibrosis and the relationship to fungal exposure which I thinh has been ongoing for about 20 years. Can you estimate the probability of PF or any other serious diseases based on my ct? I'm trying to get a % if possible. I'm otherwise healthy, quit smoking 33 years ago(after 34 pack years) and am physically very active on a daily basis Had a normal cbc and complete blood count 7 weeks ago. Thanks for your expertise and time. A rough percentage would be very nice. XXXXXXX XXXXXXX

I failed to mention that this is a follow-up to a question including my ct results sent recently.

I failed to mention that this is a follow-up to a question including my ct results sent recently.

Thank you - I have a CD Disk with my test results which the system will not let me upload. I took about 50 screenshots and uploaded them if that is helpful. If you need the full set of images to accurately make a diagnosis I would be happy to upload the rest of the images or if you know of a better way to get the images to you that would be great.

Thank you - I have a CD Disk with my test results which the system will not let me upload. I took about 50 screenshots and uploaded them if that is helpful. If you need the full set of images to accurately make a diagnosis I would be happy to upload the rest of the images or if you know of a better way to get the images to you that would be great.

Also please see the report below with commentary from radiologist

Impression
New bilateral pulmonary nodules measuring up to 4 mm as detailed above.
Scattered areas of tree-in-bud nodularity are also new in interval. The
findings may reflect inflammatory changes. These nodules are
categorized as lung RADS category 3, probably benign. Six-month
follow-up low-dose chest CT is recommended for further surveillance.


ACR Lung-RADS Category/Recommendations:
0: Need prior comparisons or additional images
1: Negative: 12 month follow up LDCT (Low Dose CT)
2: Benign Appearing: 12 month follow up LDCT
3: Probably Benign: 6 month follow up LDCT
4A: Suspicious: 3 month follow up LDCT (or immediate PET if >7mm solid
component)
4B: Suspicious: Immediate Chest CT or PET if >7mm solid component
4X: Cat 3 or 4A nodules with additional suspicious findings
Modifier-"S": Significant NON-lung cancer findings
Modifier-"C": Prior treated Lung Cancer.

For details of the ACR Lung-RADS program, categories and
recommendations:
1) https://www.acr.org/Quality-Safety/Resources/LungRADS
2) Internet search: "Lung-RADS Lung Cancer Screening"
3) Contact SSM thoracic nurse coordinator (636-639-8640)
______________________



Reading Radiologist: Chadwick, Nicholson MD on 11/16/2018 at 10:53 AM

Narrative
CT chest without contrast

HISTORY: Former smoker. Follow-up pulmonary nodules

COMPARISON: CT chest favors 7 2018, CT chest XXXXXXX 8, 2017

Technique: Axial images were acquired through the chest without
contrast. Multiplanar reconstructions were reviewed.

FINDINGS:
The soft tissues the visualized lower neck and chest wall are
unremarkable. The thyroid enhances homogeneously. There is no
mediastinal or axillary lymphadenopathy by CT size criteria. Technique
limits evaluation for hilar lymph nodes. The heart is normal in size.
There is no significant pericardial fluid collection. The esophagus is
unremarkable. The caliber of the ascending thoracic aorta and main
pulmonary artery are normal. Scattered atherosclerotic vascular
calcifications are identified.

The major airways are patent. There is no focal consolidation, pleural
effusion, or pneumothorax. Linear atelectasis is identified in the
medial segment of the left lower lobe. Biapical pleural scarring is
noted. New nodularity in the anterior aspects of the left lower lobe is
noted measuring 2 mm. This may represent a small vessel. Oblong 4 mm
nodule in the lateral aspect of the right lower lobe is unchanged,
series 3 image 218. 2 mm nodules in the right lower lobe were not
previously seen, series 3 image 228, 286, 293. A new 4 mm nodule is
identified in the lateral aspect of the left upper lobe, series 3 image
166. Subtle tree-in-bud and groundglass nodularity is identified in the
medial aspect of the left upper lobe, series 3 image 11 for example.
This is more apparent versus the comparison study. Additional new
nodules in the mid aspect of the left lower lobe and tree-in-bud
nodularity is noted, series 3 image 269-277. These nodules measure 2-3
mm. New 3 mm nodule identified in the left lower lobe, series 3 image
225.

Limited view of the subdiaphragmatic structures demonstrates no acute
findings.

Nonacute appearing left-sided rib fractures noted. No destructive
osseous lesions are identified. Vertebral body heights are maintained.

Also please see the report below with commentary from radiologist

Impression
New bilateral pulmonary nodules measuring up to 4 mm as detailed above.
Scattered areas of tree-in-bud nodularity are also new in interval. The
findings may reflect inflammatory changes. These nodules are
categorized as lung RADS category 3, probably benign. Six-month
follow-up low-dose chest CT is recommended for further surveillance.


ACR Lung-RADS Category/Recommendations:
0: Need prior comparisons or additional images
1: Negative: 12 month follow up LDCT (Low Dose CT)
2: Benign Appearing: 12 month follow up LDCT
3: Probably Benign: 6 month follow up LDCT
4A: Suspicious: 3 month follow up LDCT (or immediate PET if >7mm solid
component)
4B: Suspicious: Immediate Chest CT or PET if >7mm solid component
4X: Cat 3 or 4A nodules with additional suspicious findings
Modifier-"S": Significant NON-lung cancer findings
Modifier-"C": Prior treated Lung Cancer.

For details of the ACR Lung-RADS program, categories and
recommendations:
1) https://www.acr.org/Quality-Safety/Resources/LungRADS
2) Internet search: "Lung-RADS Lung Cancer Screening"
3) Contact SSM thoracic nurse coordinator (636-639-8640)
______________________



Reading Radiologist: Chadwick, Nicholson MD on 11/16/2018 at 10:53 AM

Narrative
CT chest without contrast

HISTORY: Former smoker. Follow-up pulmonary nodules

COMPARISON: CT chest favors 7 2018, CT chest XXXXXXX 8, 2017

Technique: Axial images were acquired through the chest without
contrast. Multiplanar reconstructions were reviewed.

FINDINGS:
The soft tissues the visualized lower neck and chest wall are
unremarkable. The thyroid enhances homogeneously. There is no
mediastinal or axillary lymphadenopathy by CT size criteria. Technique
limits evaluation for hilar lymph nodes. The heart is normal in size.
There is no significant pericardial fluid collection. The esophagus is
unremarkable. The caliber of the ascending thoracic aorta and main
pulmonary artery are normal. Scattered atherosclerotic vascular
calcifications are identified.

The major airways are patent. There is no focal consolidation, pleural
effusion, or pneumothorax. Linear atelectasis is identified in the
medial segment of the left lower lobe. Biapical pleural scarring is
noted. New nodularity in the anterior aspects of the left lower lobe is
noted measuring 2 mm. This may represent a small vessel. Oblong 4 mm
nodule in the lateral aspect of the right lower lobe is unchanged,
series 3 image 218. 2 mm nodules in the right lower lobe were not
previously seen, series 3 image 228, 286, 293. A new 4 mm nodule is
identified in the lateral aspect of the left upper lobe, series 3 image
166. Subtle tree-in-bud and groundglass nodularity is identified in the
medial aspect of the left upper lobe, series 3 image 11 for example.
This is more apparent versus the comparison study. Additional new
nodules in the mid aspect of the left lower lobe and tree-in-bud
nodularity is noted, series 3 image 269-277. These nodules measure 2-3
mm. New 3 mm nodule identified in the left lower lobe, series 3 image
225.

Limited view of the subdiaphragmatic structures demonstrates no acute
findings.

Nonacute appearing left-sided rib fractures noted. No destructive
osseous lesions are identified. Vertebral body heights are maintained.

Are you saying that if PF was a concern, it would have been noted in the written report?

Are you saying that if PF was a concern, it would have been noted in the written report?

Thank you so much for your timely answer!

Thank you so much for your timely answer!