Question: Hello,

I would like to consult with a Radiologist to review some CT images, if possible. I am concerned about lung malignancy. Mainly Bronchoalveolar Carcinoma worries me.

Below I have listed the relevant studies with Online Viewing links. Please let me know if I can get a reading and evaluation of these scans.

Thank you!

Relevant Symptom History: Shortness of breath, Coughing, Nail Clubbing for 3.5 months
Note: Everything to the right of the ">" symbol should be click-able as a URL Link

>>(12/22/16) CT Chest With Contrast (PE contrast XXXXXXX protocol) -- http://www.dicomlibrary.com/?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000

If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaeXAyWFZ4M2hGeEE


>>(12/02/16) Noncontrast CT Chest (Helical, with HRCT reformats also taken) -- http://www.dicomlibrary.com/meddream/index.php?study=1.2.826.0.1.0000.8.1055.1.0000.0000.0000

If above DICOM Viewer link is not working, for JPEG images only = http://drive.google.com/open?id=0B8VVRuIADGiaR19FRUx2R2hJMkk

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1) The original radiologist had seen a geographic ground glass opacity on the Chest CT w/ Contrast. Can you please tell me if that GGO looks malignant? I am wondering about the following likely malignant characteristics...
--How large would you estimate it? Say 10 mm, 2 cm, etc.?
--Are the margins clear-cut or ill-defined?
--As for shape, is it nonpolygonal or is it polygonal?
--Is there any apparent radial growth?
--Is there any spiculation on the border?
--Is "bubble lucency" present?

2) Why was that Ground glass opacity (or any other abnormality) not seen on the Noncontrast Chest CT?
Both studies were done at roughly the same scan parameters, in supine position...only difference was use of contrast XXXXXXX

Thank you doctor.

1) Can you point out on the image where the ground glass opacity is?
2) Why is it not visible on Noncontrast CT (done at High Resolution, helical)?

3) Would you characterize the ground glass opacity interface as:
a) ill-defined
b) well-defined and smooth
c) well-defined but coarse = (which I have heard is most likely for malignancy)

4) Is bronchoalveolar carcinoma possible with this presentation?

Hi doctor,

Thanks for your explanation

1) Which section/image in the series can I look at to find this ground glass opacity?

2) The HRCT (lung window) Noncontrast done on Dec. 02, 2016 did not seem to show the Ground glass finding or any other abnormality at all.

The pulmonologist said that if the ground glass was seen on Contrast exam, he would order Noncontrast HRCT to re-evaluate the area.

So if I am not wrong, the Noncontrast Dec. 02, 2016 exam is considered the superior test for ground glass evaluation as opposed to the Contrast exam, right?

3) Also, I had done the HRCT Noncontrast as Inspiratory scan whereas the Contrast exam was done on a machine that did not require inhalation. Does this cause any differences?

4) Is there any kind of follow-up study that can be done?

Thank you doctor.

Just a few more doubts...

--Would you say that the Noncontrast HRCT (Dec. 02, 2016) I have attached has adequately studied the lungs?

--What slice number in series 7 should I be looking at?

Hi doctor,

I have attached "Noncontrast-Lung-Window-Images.pdf" file which has visualized portion of lung bases on the Noncontrast Scan.

--Does it look technically adequate?

-Please review, compare to contrast, and let me know your feedback.

Thank you!