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What Does My Scan Report Indicate?
Question: Hi doctor,
I am a 36 year old female. I have lung lesions which should be caused by TB infection as my mother had TB 21 years ago. My lung lesions was found 10 years ago in a health screening. I was never treated for TB.
The largest lesion (around 1cm) on my recent x-rays appear smaller and less well-defined. My doctor think the lesion may be softening and I may be having active TB. I did a CT scan, and the CT shows no sign of active TB. The lesions look pretty much the same as in the CT scan I did 10 years ago. I learned that if the lesion is calcified, then my chance of having TB reactivation is much lower. So I am trying to figure out whether my lesion is calcified or not and whether I need to take preventative therapy for TB.
The reading of my largest lesion I got from my CT DICOM file using a DICOM viewer is between 20 to 180. However, the reading I got from my radiologist on the same lesion can be as high as 426. My CT is done with SIMENS SOMATOM Definition Flash with IV contrast (Iodine) and my rediologist uses Simens syngo via VA30A software to produce the reading. I am very confused by the two readings. Which reading should I use as the hounsfield reading of my lesion? Also how much the contrast will increase the reading?
Given my condition, I have several options:
1. No drugs now, and do X-ray follow-up every year or every 6 months
2. take preventative therapy, and use 9-month of Isoniazid
3. take two drugs as preventative therapy as I have lung lesions and this is more serious than latent TB without lesions.
4. take active TB treatment (4 drugs for 2 months and then 2 drugs for 4 months)
I want to seek advice on which option should I take. If I do not take any treatment now, what's my chance of having active TB in the future?
If I take either preventative therapy or even active TB treatment, I am concerned of the side effects of the drugs and the possibility of drug-resistance since there is no way to know whether the drugs are effective or not as I do not have any symptoms now.
Thanks a lot for the help.
I am a 36 year old female. I have lung lesions which should be caused by TB infection as my mother had TB 21 years ago. My lung lesions was found 10 years ago in a health screening. I was never treated for TB.
The largest lesion (around 1cm) on my recent x-rays appear smaller and less well-defined. My doctor think the lesion may be softening and I may be having active TB. I did a CT scan, and the CT shows no sign of active TB. The lesions look pretty much the same as in the CT scan I did 10 years ago. I learned that if the lesion is calcified, then my chance of having TB reactivation is much lower. So I am trying to figure out whether my lesion is calcified or not and whether I need to take preventative therapy for TB.
The reading of my largest lesion I got from my CT DICOM file using a DICOM viewer is between 20 to 180. However, the reading I got from my radiologist on the same lesion can be as high as 426. My CT is done with SIMENS SOMATOM Definition Flash with IV contrast (Iodine) and my rediologist uses Simens syngo via VA30A software to produce the reading. I am very confused by the two readings. Which reading should I use as the hounsfield reading of my lesion? Also how much the contrast will increase the reading?
Given my condition, I have several options:
1. No drugs now, and do X-ray follow-up every year or every 6 months
2. take preventative therapy, and use 9-month of Isoniazid
3. take two drugs as preventative therapy as I have lung lesions and this is more serious than latent TB without lesions.
4. take active TB treatment (4 drugs for 2 months and then 2 drugs for 4 months)
I want to seek advice on which option should I take. If I do not take any treatment now, what's my chance of having active TB in the future?
If I take either preventative therapy or even active TB treatment, I am concerned of the side effects of the drugs and the possibility of drug-resistance since there is no way to know whether the drugs are effective or not as I do not have any symptoms now.
Thanks a lot for the help.
Brief Answer:
no need to worry much for difference in reading.
Detailed Answer:
Hello dear, thanks for your question on HCM.
In my opinion you should not worry about difference in reading.Size of lesion on recent CT scan is same with the one which is 10 years older. So your lesion is static over the years. This means it is only a healed scar tissue. And yes, you are right that if lesion has calcification, it has very very less chance of being an active infection.
So you should not worry because
1. Your lesion is calcified
2. It is static since 10 years.
And regarding treatment of this I advice you not to take any treatment or prophylaxis for this. As it is not active lesion and you are totally asymptotic.
And no need for prophylaxis as you are not having any pulmonary TB contact at present.
No need for 2 drug therapy as it will increase chance of resistance.
No need for full four drug therapy as it is not active lesion. This will give you side effects.
And no need to do regular follow up with chest x ray and CT too. This is recommended only when you have chest symptoms like cough, expectoration, fever etc.
So no need to worry and start any kind of treatment for this.
I advice you to get done BCG vaccination if not done previously. This will give you protection.
And if you are following healthy lifestyle with healthy diet and regular exercise,no chance of active TB in future.
Hope I have solved your query. I will be happy to help you further.
Wish you good health.
Thanks.
no need to worry much for difference in reading.
Detailed Answer:
Hello dear, thanks for your question on HCM.
In my opinion you should not worry about difference in reading.Size of lesion on recent CT scan is same with the one which is 10 years older. So your lesion is static over the years. This means it is only a healed scar tissue. And yes, you are right that if lesion has calcification, it has very very less chance of being an active infection.
So you should not worry because
1. Your lesion is calcified
2. It is static since 10 years.
And regarding treatment of this I advice you not to take any treatment or prophylaxis for this. As it is not active lesion and you are totally asymptotic.
And no need for prophylaxis as you are not having any pulmonary TB contact at present.
No need for 2 drug therapy as it will increase chance of resistance.
No need for full four drug therapy as it is not active lesion. This will give you side effects.
And no need to do regular follow up with chest x ray and CT too. This is recommended only when you have chest symptoms like cough, expectoration, fever etc.
So no need to worry and start any kind of treatment for this.
I advice you to get done BCG vaccination if not done previously. This will give you protection.
And if you are following healthy lifestyle with healthy diet and regular exercise,no chance of active TB in future.
Hope I have solved your query. I will be happy to help you further.
Wish you good health.
Thanks.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi doctor,
Thanks for the information.
I understand that if I am healthy then my chance of having active TB is low. If I get old and have other major diseases, then will the reactivation chance will be much higher? If I need to take steroid to treat other conditions in the future, do I need to do prophylaxis first?
I also want to know more about side effects of the drugs. Are side effect much more serious for old people? For prophylaxis, one drug is used and for active TB treatment, four drugs are used. Can I consider the side effects of active TB treatment is roughly four times of that of prophylaxis?
Thanks for your help.
XXXX
Thanks for the information.
I understand that if I am healthy then my chance of having active TB is low. If I get old and have other major diseases, then will the reactivation chance will be much higher? If I need to take steroid to treat other conditions in the future, do I need to do prophylaxis first?
I also want to know more about side effects of the drugs. Are side effect much more serious for old people? For prophylaxis, one drug is used and for active TB treatment, four drugs are used. Can I consider the side effects of active TB treatment is roughly four times of that of prophylaxis?
Thanks for your help.
XXXX
Brief Answer:
no need to worry much.
Detailed Answer:
Hello dear, thanks for your follow up question.
Even if in old age, you are healthy and fit than chances of reactivation TB are very less. So old age should not be the criteria for prophylaxis.
But if in future you have any disease which needs steroids or other immunosuppressive drugs than you have to take prophylaxis first.
Anti TB drugs can cause side effects like gastritis, vomiting, drug induced hepatitis, skin rashes, neuropathy etc.
And yes, side effects are more commonly seen in old age.
Prophylaxis carries single drug. So side effects will be less than full four drug treatment. Roughly four times lesser.
Hope I have solved your query.
If you are not having further queries, please close the conversation and rate the answer.
Wish you good health.
Thanks.
no need to worry much.
Detailed Answer:
Hello dear, thanks for your follow up question.
Even if in old age, you are healthy and fit than chances of reactivation TB are very less. So old age should not be the criteria for prophylaxis.
But if in future you have any disease which needs steroids or other immunosuppressive drugs than you have to take prophylaxis first.
Anti TB drugs can cause side effects like gastritis, vomiting, drug induced hepatitis, skin rashes, neuropathy etc.
And yes, side effects are more commonly seen in old age.
Prophylaxis carries single drug. So side effects will be less than full four drug treatment. Roughly four times lesser.
Hope I have solved your query.
If you are not having further queries, please close the conversation and rate the answer.
Wish you good health.
Thanks.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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