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What Do These CT Scan Findings Indicate?
Question: sir my father have been diagnose by ct chest contrast study HRCT SAYING ..areas of honeycombing are also noted,more prominent in the basal segments bilaterally-IPF/connective tissue disorder.
visceral pleural irregularity noted...oesophageal wall thickening...atherosclerotic changes in aorta &branches
impression
features suggestive of interstitial lung disease (likely IPF)
what should i do ???can i avoid vats lung biopsy??is this curable ??how much time??/
visceral pleural irregularity noted...oesophageal wall thickening...atherosclerotic changes in aorta &branches
impression
features suggestive of interstitial lung disease (likely IPF)
what should i do ???can i avoid vats lung biopsy??is this curable ??how much time??/
Brief Answer:
VATS Lung biopsy is advisable.
Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through the query, I would like to comment the following:
1. The radiological features (CT Scan findings) are suggestive of Idiopathic Pulmonary Fibrosis subject to condition of clinicopathological correlation. Honey combing increases the likelihood of IPF.
2. VATS Lung biopsy will help confirm the etiology of IPF.
3. Just some queries to rule out other possible etiology of pulmonary fibrosis-
Is your father a current or ex smoker?
What is the work he does/ used to do / his occupation?
Any sort of inhaled exposure -- dust , fumes , smoke, industry bear your house , excessive pollution, pets at home ,etc. ?
Any other disease/ taking medicines for any other disease?
In absence of any of the above factors the disease can be labelled as IPF based on investigations.
4. Connective tissue diseases need to be ruled out. Specific Investigations that are required are Extractable nuclear antigen profile, Serum ACE levels, RA Factor, LE cells ,CRP, Serum calcium.
5. If IPF is diagnosed, then its a hard fact that the disease is not curable (curable means reverting back to the normal state) however the main target of medical management is to reduce/ slow down the further progression of the disease. The disease is found to have very variable course in different individuals. In some individuals the disease tends to be relatively static over time while in others it progresses rapidly. Hence its difficult the predict the trend of disease progression but its a fact that the disease does progress over time.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
VATS Lung biopsy is advisable.
Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through the query, I would like to comment the following:
1. The radiological features (CT Scan findings) are suggestive of Idiopathic Pulmonary Fibrosis subject to condition of clinicopathological correlation. Honey combing increases the likelihood of IPF.
2. VATS Lung biopsy will help confirm the etiology of IPF.
3. Just some queries to rule out other possible etiology of pulmonary fibrosis-
Is your father a current or ex smoker?
What is the work he does/ used to do / his occupation?
Any sort of inhaled exposure -- dust , fumes , smoke, industry bear your house , excessive pollution, pets at home ,etc. ?
Any other disease/ taking medicines for any other disease?
In absence of any of the above factors the disease can be labelled as IPF based on investigations.
4. Connective tissue diseases need to be ruled out. Specific Investigations that are required are Extractable nuclear antigen profile, Serum ACE levels, RA Factor, LE cells ,CRP, Serum calcium.
5. If IPF is diagnosed, then its a hard fact that the disease is not curable (curable means reverting back to the normal state) however the main target of medical management is to reduce/ slow down the further progression of the disease. The disease is found to have very variable course in different individuals. In some individuals the disease tends to be relatively static over time while in others it progresses rapidly. Hence its difficult the predict the trend of disease progression but its a fact that the disease does progress over time.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Is your father a current or ex smoker?
no ...he is not current smoker...but was smoking 12- 15 years back occasionally very rarely.
What is the work he does/ used to do / his occupation?
he have 50 acres of land in which he Cultivation soyabean seeds and cotton .we have own Thresher while threshing soyabean its dust and husk in air .he manages daily work in farm and cattle shed were there is dust .in past we had soybean seed and cotton trading in which we buy from farmers & send to mills. now we have agro input shop but managed by elder son.
Any sort of inhaled exposure -- dust , fumes , smoke, industry bear your house , excessive pollution, pets at home ,etc. ?
yes we have pets near home a cattle shed having 20 cows 4buffelo and one dog
daily cleaning work is done by worker which have dust while cleaning.
Any other disease/ taking medicines for any other disease?
suger ...PPG MET 0.2
DIANORM
STARVAS10
DULANE20
dr XXXXXXX chennamchetty ..... lumenac 600 syr XXXXXXX
dr please see pdf and whole profile....please
what are charges of vats lung biopsy ?
were to do it..??best hospital ?
my father is scared of operation for vats lung biopsy is there any side effect of that ??
all information above is of just 4/5 days old before that he was taking treatment from XXXXXXX from 1.5 years old hrct report is also uploaded along with treatment .please advice me i am eagerly waiting
no ...he is not current smoker...but was smoking 12- 15 years back occasionally very rarely.
What is the work he does/ used to do / his occupation?
he have 50 acres of land in which he Cultivation soyabean seeds and cotton .we have own Thresher while threshing soyabean its dust and husk in air .he manages daily work in farm and cattle shed were there is dust .in past we had soybean seed and cotton trading in which we buy from farmers & send to mills. now we have agro input shop but managed by elder son.
Any sort of inhaled exposure -- dust , fumes , smoke, industry bear your house , excessive pollution, pets at home ,etc. ?
yes we have pets near home a cattle shed having 20 cows 4buffelo and one dog
daily cleaning work is done by worker which have dust while cleaning.
Any other disease/ taking medicines for any other disease?
suger ...PPG MET 0.2
DIANORM
STARVAS10
DULANE20
dr XXXXXXX chennamchetty ..... lumenac 600 syr XXXXXXX
dr please see pdf and whole profile....please
what are charges of vats lung biopsy ?
were to do it..??best hospital ?
my father is scared of operation for vats lung biopsy is there any side effect of that ??
all information above is of just 4/5 days old before that he was taking treatment from XXXXXXX from 1.5 years old hrct report is also uploaded along with treatment .please advice me i am eagerly waiting
Brief Answer:
VATS lung biopsy will help.
Detailed Answer:
Hi,
Thanks for the follow up query. After going through the follow up query, I would like to comment the following:
1. A number of inhaled insults are present in your father's case. He also has past history of occasional smoking. Lung disease as a result of these inhaled exposures need to be ruled out. Chronic Hypersensitive pneumonitis , Collagen vascular diseases need to be ruled out besides IPF.
2. Serial ct scan thorax reports show progression of disease form the fact that honey combing has appeared in the new report.
3. Investigations as advised in point 4 in previous post may be done.
4. VATS lung biopsy will help in diagnosis.
5. It can be done at any tertiary care hospital preferably where a CVTS back up is available. As such it is a diagnostic prodedure. Please be under a regular follow up of a Pulmonologist and he will guide you regarding you concerns for the diagnostic test site / hospital based on his experience and familiarity whith the setup available at the particular site where you are evaluated. You may contact the hospital in advance for details regarding charges.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
VATS lung biopsy will help.
Detailed Answer:
Hi,
Thanks for the follow up query. After going through the follow up query, I would like to comment the following:
1. A number of inhaled insults are present in your father's case. He also has past history of occasional smoking. Lung disease as a result of these inhaled exposures need to be ruled out. Chronic Hypersensitive pneumonitis , Collagen vascular diseases need to be ruled out besides IPF.
2. Serial ct scan thorax reports show progression of disease form the fact that honey combing has appeared in the new report.
3. Investigations as advised in point 4 in previous post may be done.
4. VATS lung biopsy will help in diagnosis.
5. It can be done at any tertiary care hospital preferably where a CVTS back up is available. As such it is a diagnostic prodedure. Please be under a regular follow up of a Pulmonologist and he will guide you regarding you concerns for the diagnostic test site / hospital based on his experience and familiarity whith the setup available at the particular site where you are evaluated. You may contact the hospital in advance for details regarding charges.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
sir
yesterday i have visited our old dr mahindrakar @ XXXXXXX and showed him all reports .he was not happy that i have visited Apollo hyd .we had palmonery test yesterday in which fvc 56% and muc 52%.he advised not to undergo vats lung biopsy and given following medicine .
1. PERFETAB 200
2.LUMENAC CAP
3.ELCOPEN CAP
4.LIMCEE TAB
5.DERIPHYLLIN OD 300MG TAB
6.ELPRA-D TAB
said ipf is there but don't undergo vats lung biopsy we can give steroids and had given before also ....i have attached med 1 pdf and med 2 pdf .vats lung biopsy have dis adv as bleeding and air ?? i am bit confused to proceed with above medicine or to have vats lung biopsy ???
or i have no option then to have vats lung biopsy ( if what to have proper treatment )??
sir i admire your kind advice and quick follow ups ...thanks for guiding me
yesterday i have visited our old dr mahindrakar @ XXXXXXX and showed him all reports .he was not happy that i have visited Apollo hyd .we had palmonery test yesterday in which fvc 56% and muc 52%.he advised not to undergo vats lung biopsy and given following medicine .
1. PERFETAB 200
2.LUMENAC CAP
3.ELCOPEN CAP
4.LIMCEE TAB
5.DERIPHYLLIN OD 300MG TAB
6.ELPRA-D TAB
said ipf is there but don't undergo vats lung biopsy we can give steroids and had given before also ....i have attached med 1 pdf and med 2 pdf .vats lung biopsy have dis adv as bleeding and air ?? i am bit confused to proceed with above medicine or to have vats lung biopsy ???
or i have no option then to have vats lung biopsy ( if what to have proper treatment )??
sir i admire your kind advice and quick follow ups ...thanks for guiding me
Brief Answer:
Treatment for IPF has been started.
Detailed Answer:
Hi,
Thanks for the follow up. After going throught the follow up query, I would like to comment the following:
1. If the radiological features are highly suggestive of IPF other than any other differential diagnosis then biopsy is not required. Your previous hrct thorac report had plenty og GGO (ground glass opacities). GGOs is normally not found in IPF. Over time it has progressed to honey combing. Honey combing is found in IPF. For a diagnosis of IPF other known etiologies have to be ruled out. In your case they are present.
2. VATS lung biopsy is a diagnostic procedure. Normally the ICD tube will be insitu for 24 to 48 hours post procedure after which the air and blood if any are drained out.
3. Another option is to go for a bronchoscopic lung biopsy which has a lesser complication rate. Also the BAL(Broncho alveolar lavage) fluid examination provides vital clues
4. However, since your pulmonologist has clinically examined you and has seen the original hrct thorax films I would advise you to discuss any further intervention in consultation with your pulmonologist and under his guidance.
5. Also once the line of management has been decided it is better to stick to one line of management rather than swapping as per opinions of different doctors as different doctors may have different approaches to the same patient.
6. A biopsy if available generally will give your physician additional help in confirmation of diagnosis especially consideing the presence of multiple etiological factors as in your case.
7. Also please try to get the investigations in point 4 done prior to initiation of treatment, in consultation with your doctor (post 1) so as to rule out other possible diagnoses.
8. In the current scenario, if the treatment has been started under care of Pulmonologist. I would advise to continue management protocol under guidance of Pulmonologist and not to undergo any intervention without his knowledge. Initiating treatment on the basis of clinico radiological diagnosis is acceptable if the concerned physician is confident of the diagnosis of IPF. The diagnosis of IPF is important due to its progression characteristics.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Treatment for IPF has been started.
Detailed Answer:
Hi,
Thanks for the follow up. After going throught the follow up query, I would like to comment the following:
1. If the radiological features are highly suggestive of IPF other than any other differential diagnosis then biopsy is not required. Your previous hrct thorac report had plenty og GGO (ground glass opacities). GGOs is normally not found in IPF. Over time it has progressed to honey combing. Honey combing is found in IPF. For a diagnosis of IPF other known etiologies have to be ruled out. In your case they are present.
2. VATS lung biopsy is a diagnostic procedure. Normally the ICD tube will be insitu for 24 to 48 hours post procedure after which the air and blood if any are drained out.
3. Another option is to go for a bronchoscopic lung biopsy which has a lesser complication rate. Also the BAL(Broncho alveolar lavage) fluid examination provides vital clues
4. However, since your pulmonologist has clinically examined you and has seen the original hrct thorax films I would advise you to discuss any further intervention in consultation with your pulmonologist and under his guidance.
5. Also once the line of management has been decided it is better to stick to one line of management rather than swapping as per opinions of different doctors as different doctors may have different approaches to the same patient.
6. A biopsy if available generally will give your physician additional help in confirmation of diagnosis especially consideing the presence of multiple etiological factors as in your case.
7. Also please try to get the investigations in point 4 done prior to initiation of treatment, in consultation with your doctor (post 1) so as to rule out other possible diagnoses.
8. In the current scenario, if the treatment has been started under care of Pulmonologist. I would advise to continue management protocol under guidance of Pulmonologist and not to undergo any intervention without his knowledge. Initiating treatment on the basis of clinico radiological diagnosis is acceptable if the concerned physician is confident of the diagnosis of IPF. The diagnosis of IPF is important due to its progression characteristics.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
sir
as you said rightly ..he was given PERFETAB 200 on 23 march 2015 60 tablets and was not feeling well since then for last two months .so we decided and visited Apollo @Hyderabad .
above tablets in last question had not been bout .
but in last 12-15 days he is not consuming any tablet other then syr XXXXXXX .
now he is feeling well and is not welling to have vats lung biopsy .
i am going to take him to Apollo XXXXXXX for vats lung biopsy
what is your view ...
i extremely thankful to you in clearing my doubts and advising me ,,,
thanks a lot ...
as you said rightly ..he was given PERFETAB 200 on 23 march 2015 60 tablets and was not feeling well since then for last two months .so we decided and visited Apollo @Hyderabad .
above tablets in last question had not been bout .
but in last 12-15 days he is not consuming any tablet other then syr XXXXXXX .
now he is feeling well and is not welling to have vats lung biopsy .
i am going to take him to Apollo XXXXXXX for vats lung biopsy
what is your view ...
i extremely thankful to you in clearing my doubts and advising me ,,,
thanks a lot ...
Brief Answer:
Please do include your pulmonologist in your decision making also.
Detailed Answer:
Hi,
Thanks for the follow up info. After going through the info, I would like to comment the following:
1. A lung biopsy will help in diagnosis. But please ask the concerned doctor to explain you the procedure in detail and all the possible risks also which are a part of any medical procedure.
2. Starting treatment after confirmation of diagnosis should be a good choice.
3. Also please involve your Pulmonologist also in your decision making if possible.
4. After consulting with involved doctors regarding the risk benefit assessment, you can go ahead.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Please do include your pulmonologist in your decision making also.
Detailed Answer:
Hi,
Thanks for the follow up info. After going through the info, I would like to comment the following:
1. A lung biopsy will help in diagnosis. But please ask the concerned doctor to explain you the procedure in detail and all the possible risks also which are a part of any medical procedure.
2. Starting treatment after confirmation of diagnosis should be a good choice.
3. Also please involve your Pulmonologist also in your decision making if possible.
4. After consulting with involved doctors regarding the risk benefit assessment, you can go ahead.
I will be glad to answer follow up queries if any. Please accept my answer if you have no follow up queries.
Regards
Dr. Gyanshankar Mishra
MBBS MD DNB
Consultant Pulmonologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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