I Have A Pulmonary Question. I Have Hypersensitive Pneumonitis .

Posted on Thu, 4 Oct 2018

Question: I have a pulmonary question. I have hypersensitive pneumonitis. My pulmonologist stated that my recent CT scan showed minor scars. He said they were not fibrosis. Is this possible? I thought all lung scarring is fibrotic?

Follow up: Dr. Ornela Ademovi (1 hour later)

I was told by National Jewish Health Respiratory Institute in NYC that I do not have fibrosis. So why would I have some scars? My local pulmonologist said they were from previous infection. I had pneumonia as a child.

Answered by Dr. Ornela Ademovi (4 hours later)

Brief Answer:
Minor scars vs. generalized scarring

Detailed Answer:
Hello and thank you for using the "Ask a doctor" service for your health related questions.

I went carefully through the reports you have provided and here is my opinion.

All lung scarring is essentially made of fiber (scar) tissue, i,e. fibrotic. However it can present in a wide range. Diseases such as pneumonia (bacterial, viral or fungal), tuberculosis, as well as smoking, certain medications and cancer treatment may cause minor scarring, which affects the tissue and the area surrounding the air sacs of the lungs.
Pulmonary fibrosis, on the other hand, involves scar tissue in larger areas of the lung.
However, what I find disconcerting, is that, according to the reports, you have also been diagnosed with Intersticial lung disease (ILD) which is basically generalized inflammation of the tissue surrounding the air sacs in the lung. This inflammation, in some cases, may turn into a build up of scar tissue within the lungs resulting in pulmonary fibrosis.
So, what I understand from the test results and from the feedback you have had from doctors, at present there is minor scar tissue as well as generalized tissue inflammation which carries the risk of turning into fibrosis.
Proper monitoring of the lungs, lifestyle changes such as quitting smoking, a healthy diet, medication that stops the scarring process, moderate exercise and possibly an oxygen mask are all very effective preventive measures.
Make sure you have frequent check up and discuss the above with your doctor.

I hope I have answered your question. Let me know if I can assist you further.

Take care.

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Ornela Ademovi (13 hours later)

Thank you so much for your response. I guess there is no way of really knowing if scarring even if minor can become progressive? It's mostly wait and see?
Thank you.

Answered by Dr. Ornela Ademovi (22 hours later)

Brief Answer:
Minor old scars carry no risk of progression

Detailed Answer:

Minor scars due to previous lung infections or diseases do not carry a risk of progression. They are permanent but not harmful. However, you have been diagnosed (as per the reports) with Interstitial Lung Disease, which does carry a risk a progression to fibrosis and more extensive scarring. Please discuss with your doctor on the ways of preventing this progression. You may also refer to the preventive measures I have provided in the previous answer.

I hope this helps. Let me know if I can assist you further.

Take care.

Above answer was peer-reviewed by : Dr. Prasad