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What Does Increased Interstitial Lung Markings Indicate?

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Posted on Sat, 26 Jul 2014
Question: I had a hrct scan and the radiologist said there were some evidence of intertitial markings at both lung bases bilaterally locallised to the posteria segments of the lower lobes. No other problems and said the markings could be a sequela of a previous inflammatory event or could indicate changes of early IPF. Does'nt both options mean I have now a life span of 2 -5 years as all scaring is progessive? At the moment I have normal lung capacity, no shortage of breath or chronic cough and all blood work has been clear. Obviously I am very worried.
I have never smoked but have built recreational yachts for myself which has included sanding of fibreglass and spraypainting over the last 15 years although I always wore a mask
doctor
Answered by Dr. Shashi Dangwal (2 hours later)
Brief Answer:
Only HRCT findings cannot be conclusive.

Detailed Answer:
Hello XXXXXXX

Your radiologist has correctly reported that increased interstitial lung markings may indicate some old inflammation or early IPF.

But the good thing is that you have no symptoms and you are not a smoker.

Just because you have certain findings on hrct lungs, does not mean that you are suffering from the disease as clinical correlation is required. It certainly does not mean that you have a lifespan of only 2 to 3 years. These may just be incidental findings.

You should get a pft and diffusion studies done to see the functional aspect of your lungs. If required, a bronchoscopy may be done where in some fluid and tissue is taken from the lungs and examined. Consult a local pulmonologist for the same.

Dust of fibreglass and fumes of spray paint may adversely affect the lungs but again good thing is you wore mask. It is difficult to say definitely if that affected your lungs.

Regards,

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Shashi Dangwal (33 hours later)
Thank you for your prompt reply.

I'm not sure what relevance the following might also have but 11 years ago I went through a particularly stressful time at work. I left and took a year off. About 8 months later I was hiking and felt my heart flutter - no pain but a funny beat. It went in a day. A year later I had it again and saw a heart specialist who put me on a 24hr heart monitor.

They noted I had a heart at rest rate of 64bp. The monitor results showed everything normal.

4 Years later I had it again and saw a cardiologist who did another 24hr monitor plus a range of blood and stress tests. My heart at rest rate was again 64bp. I passed the stress test and blood tests with ease and the flutter went away a couple of days later but the cardiologist did say that they had detected a nerve coming off my heart into the chest cavity and occasionally some of the electrical charge was dissipated along it.

He said that I was fit and in good health but in the future they could either simply cauterise the nerve or even put in a pacemaker and that I should leave it for now and see how I go.

I got this flutter again a month ago which prompted me to go back to my doctor who has booked me into the cardiologist in August (earliest time he can see me).

I also had a tiny bit of shoulder and chest pain on the left although I had a bit of a chest infection as well so wanted to be certain so I asked for the chest X-ray. It was the chest X-ray, when compared to one I had done in 2011 that then prompted the HRCT scan and brings me to where I am now.

I see the Pulmonary Specialist in 3 days time and will take all the X-rays and scans. At the moment I have the occasional mild ache in my left chest and some in my neck but I have gotten this in the past from sleeping in a bad position. Its very confusing to know what mean what. I also am just finishing a round of antibiotics for my chest infection which has seemed to reduce the pain which is now almost gone.

I would imagine that there may be some interplay with my occasional heart fluttering and what is showing up in my lungs although I also read that shoulder and chest pain may also be a sign of IPF. Perhaps the two are unrelated - I just don't know but the chest X-rays and the blood tests last week showed no heart enlargement or disease and the CRHT scan did not mention any heart related issues either.

I know its an added complication and both the cardiologist and the pulmonary specialist will probably need to compare notes.

I have no breathing problems and yesterday I did a lung expansion test (where I fully exhaled into a machine) and my family doctor said I had normal lung strength and capacity. I also did a cholesterol test and it came back as 4.7 which I was told was good. My heart at rest rate is still 64bpm.

Now taking the above details into consideration — does this change your previous answer or suggest we should be looking at other areas and if so, which?

My wife is very distraught and confused as our daughter's wedding is in October and we are not sure if I am going to be around to give her away given that we are wondering if the 2011 chest X-ray showed the first signs of PFT and I've now had my 2 - 5 years and am about to rapidly decline and suddenly find myself on O2 or worse.

Related or two separate issues? I have no idea - which would be the most important one to deal with first and should I be contacting my cardiologist to try and make an early appointment?

Many thanks, my wife has stopped crying after seeing your response.

XXXXXXX
doctor
Answered by Dr. Shashi Dangwal (9 hours later)
Brief Answer:
My views remain the same.

Detailed Answer:

I think you are reading too between the lines.

Regarding your heart flutter, I feel there is nothing much to worry as we all have had our heart fluttering at times. But ofcourse your cardiologist is the right person to comment on it. However, I can say that your lung hrct findings and heart condition are not related.

My views remain the same even after going through your latest medical history.

My advise is that do not worry, think positive and give up negativity. Keep your appointment with your local pulmonologist and discuss all your fears with him who will be able to allay your anxiety.

Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Shashi Dangwal

Pulmonologist

Practicing since :1979

Answered : 1157 Questions

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What Does Increased Interstitial Lung Markings Indicate?

Brief Answer: Only HRCT findings cannot be conclusive. Detailed Answer: Hello XXXXXXX Your radiologist has correctly reported that increased interstitial lung markings may indicate some old inflammation or early IPF. But the good thing is that you have no symptoms and you are not a smoker. Just because you have certain findings on hrct lungs, does not mean that you are suffering from the disease as clinical correlation is required. It certainly does not mean that you have a lifespan of only 2 to 3 years. These may just be incidental findings. You should get a pft and diffusion studies done to see the functional aspect of your lungs. If required, a bronchoscopy may be done where in some fluid and tissue is taken from the lungs and examined. Consult a local pulmonologist for the same. Dust of fibreglass and fumes of spray paint may adversely affect the lungs but again good thing is you wore mask. It is difficult to say definitely if that affected your lungs. Regards,