Question: Hello Dr Rynne

I am a 50 year old, caucasian male. I have never smoked and recently underwent a pre-employment medical examination that included a chest Xray carried out twice in one week. I have have no symptoms of any kind and a recent Spirometry result was normal Exercise stress test on treadmill indicated above average work capacity at heartrate was 105% maximum for age. The report results of the XRays confuse me.
The first one reads like this:
"Findings: Hilar are prominent with a little perbronchial thickening. no collapse or consolidation is seen. Costophrenic angles are clear. Cardio-aortic outline is normal"
The second one, performed by another radiology group just a week later, reads like this:
"Cardiomediastinal contours are normal. There is mild peribronchial thickening demonstrated in the posterior recess with an apparent nodular density. This is felt likely to be related to summation artifact from bone degenerative changes, pulmonary vasculature and overlying ribs however a followup study in 6-8 weeks could be considered. Otherwise no intrapulmonary masses, nodules or overt pulmonary oedema. no suspicious osseous lesions"

My question: My doctor said these are both normal but I need to send one of these to the medical officer that is reviewing my pre-employment medical. Do you consider that these are both normal? Why are they stated so differently and which one do you think would be the best in the context of preemployment medical review?"

Thank you.
XXXXXXX

Thank you doctor XXXXXXX Bhavsar,

Brief followup question:

Do you think that if I submit the second report it looks bad for rejection? The reason is as follows:

For the first XRay, my referring GP had to put a reason for the XRay on the service request and the reason he put on is: Dyspnoea, a condition which I have never had. I didnt notice he put that on the XRay request form until I received back the report (the short one I mentioned in my original question) which had a comment that indicated my Clinical History was: Dyspnoea. I told my GP I didnt want to submit the report which said I had this history when I never had it, even though the radiology report said its all clear. I just didnt want false history indicated.

My GP said he couldnt change it but if I wanted, he could send me to a different Radiologist to do the XRay again, so I agreed and this time, on his request he put the correct reason for the XRay as Pre-employment medical.

But then, when the second report comes back, it had all that additional stuff I asked you about.

My point is I dont know what to do. Like you said, I can submit the first report which is more appropriate for my age, but it says clinical history: Dyspnoea and I dont like that being there because it is false history. Or I can submit the second report which says all the other stuff.

What do you think? My GP said I could erase the Dyspnoea if I want to (because he knows I dont have that history) but I dont feel like that is the right thing to do. Is it really ok to put in the second report instead of erasing the false clinical history from the first. I'm worried the second report has a bit of negative in it but I dont know what to do What do you think?

I really think that my GP should have called the first Radiology practice and asked them to correct the history but instead he referred me to have a second one at a different place.

I know this is ultimately my decision but to make it, I really need to feel comfortable about that second report.

Just your reassurance about that second report is all I need, especially because you said submit the first one, which is also my thinking.

Thank you.

Thanks Doctor, I really appreciate your help.

My GP seems reluctant to change clinical reason for requesting the first XRay and I suspect that is because it may not look good for him to have put Dyspnoea on the report in the first place given that I have never seen him for such a condition. Quite frustrating for me actually.

The wording on the second report is "...however a followup study in 6-8 weeks COULD be considered...."

When my GP read that report, he said the comments were nonsense and only because of the way they positioned me for the xray. He said it is ok.

The only other thing I can think of is to go to an occupational health centre and ask for yet another XRay by them. That would be 3 XRays in two weeks.

I actually feel that I am quite justified to delete the word "Dyspnoea" from the first report because it shouldn't be there in the first place which is why the GP sent me somewhere else for another XRay and didnt place that word on the second form. If there were ever an enquiry why I deleted the word, the GP records would reveal that I have never seen him for Dyspnoea. I'm not proposing to alter the the results, just the false history which should not be there anyway??

Thanks Doctor,

I have submitted the second report and let it be what may. I think stressing over this too much which would not have been necessary if my GP had done the right thing and called the original radiology practise and had the clinical history corrected. I think my stress is actually caused by that.

To answer your question I am intending to work in South XXXXXXX

Kindest regards. Your help has been greatly appreciated.

- XXXXXXX