What Does "left Hemidiaphgram Mildly Elevated" Mean?

Posted on Wed, 8 Oct 2014

Question: 2/14 chesr xray revealed left hemidiaphgram mildly elevated, mild apical pleural thickening. Interstial markings are mildly elevated as before. 4/14 diagnosed with GERD & hiatal hernia. 3/14 Cardiologist noted one heart valve functioning at low normal. When I asked what might be the cause, he said pulmonary. Saw a pulmonologist this week regarding sleep study for ongoing fatigue. He suspects chronic bronchitis., and will do respiratory testing. Anything I should ask him or any other testing I should undergo? I am 69. My 95 year old Mother has interstitial lung disease, atrial fibrillation, CAD, GERD & asthma from GERD. I have had fatigue, post nasal drip for months, sinus infection resolved, feeling of fullness or heaviness under breasts. Bras are now too tight.
Thank you in advance.

Answered by Dr. Gyanshankar Mishra (3 hours later)

Brief Answer:
Pulmonary function test will help in screening.

Detailed Answer:
Hi,
Thanks for posting the query on HCM. After going through your query, I would like to comment the following:

1. You present symptoms include - fatigue, post nasal drip and chest discomfort.
2. Post nasal drip is a known cause of bronchitis. Post nasal dripneeds to be treated. Probably chronic rhinosinusistis seems to have affected you.
3. You need to get your pulmonary function test done, which your pulmonologist has already planned. Serum Ige Levels, Complete blood count and Xray paranasal sinuses will be supporting investigations.Also if a 2d echo was done by the cardiologist, did it show pulmonary hypertension or just valvular abnormality?
4. GERD seems to be related to hiatal hernia. A proper control of gerd with medications /life style changes is required. If you are overweight, please do control your weight.
5. Advanced investigations like hrct scan thorax and sleep study may be required based on your current evaluation profile.
6. Now it is required to just follow up with your scheduled pulmonologist visit and get evaluation as advised.
7. If its plain bronchitis then probably a course of antibiotics with inhalers and nasal sprays may be required or else further evaluation will be advised.

I hope I have answered your query. 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. Yogesh D

Follow up: Dr. Gyanshankar Mishra (10 hours later)

Thank you. I should have added that I have also seen an ENT MD. An upper endoscopy & sinus CT scan revealed a deviated septum and evidence of past sinus infections, bur no other abnormalities. I have been undergoing injections for environmental allergies for about a year. The ongoing post nasal drip issue started Feb/March of this year. The ENT put me on antibiotics twice for sinus infection. There was only one echo done by the cardiologist. His comments were: normal left ventricular wall motion with left ventricular ejection fraction of 78%,
grade I diastolic dysfunction, right ventricular function by Tapse method at lower limits of normal. Pulmonary valve peak velocity 0.76. There seemed to be trace regurgitation with all valves as listed on test results. I know pulmonary hypertension is diffwrent, but my normal BP runs low to normal.

I don't know if this adds any other useful information or not. I appreciate your comments.

Answered by Dr. Gyanshankar Mishra (2 hours later)

Brief Answer:
Seems to be allergic rhinitis with post nasal drip

Detailed Answer:
Hi,
Thanks for the follow up. After going through your follow up query, I would like to comment the following:

1. You seem to be suffering from allergic rhinitis with post nasal drip.

2. Pulmonary function test will help diagnose associated obtructive or hyper-responsive airway disease.

3. You seem to be on allergen immunotherapy since one year. Nasal sprays may help you.

4. As advised above, it is required to just follow up with your scheduled pulmonologist visit and get evaluation done.

I hope I have answered your query. 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

Note: For further information on diet changes to reduce allergy symptoms or to boost your immunity, Ask here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar