Hi Mr XXXXX,
Thanks for writing in.

With the information provided, your wife 30 years of age has suffered from tuberculosis in 2007 and 2009.

I would like to explain Chest X XXXXXXX findings as you have mentioned:
1. Patchy homogeneous opacity in the right upper zone and suggest of infective etiology: This means there is some patch like formation in the right lung apex. Though no cavity formation is mentioned, it must be looked for. An infective pathology is always suspected initially in such patients as your wife.

2. Both the CP angles are clear: This is a normal finding.

3. The mediastinum including hilla are normal: This is a normal finding.

4. Trachea is central: This is a normal finding regarding airway.

5. Cardiac size and silhouette is normal and bony thorax is intact: This explains that the heart and bones are normal.

It would be great if you could send a digital format picture of the X XXXXXXX if possible.

Coming to your specific question.

Chest Tuberculosis is said to be inactive if there are no changes in Chest X XXXXXXX done 6 months apart.

Since possibilities other than tuberculosis must also be considered, starting a short course of antibiotics would be important while we still investigate for tuberculosis by various other tests.

Please look for the following and report to your treating doctor to investigate further for tuberculosis:
Cough present for more than a month.
Weight loss in last few days.
Unexplained continuous fever.

Please feel free to ask further questions.

Regards
Dr Vivek

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Hi Mr.XXXXX,
Thanks for writing in with an update.

Your doctors are doing the right thing by recommending a CT scan of Chest for your wife. This will give us additional details about the pattern of the opacity and any smaller changes that are not obvious in X XXXXXXX Chest. Its good to know that Sputum for AFB is done and reports are negative. In many patients who have chest TB, the lung remains scarred and little fibrosis may be seen for a long time on X XXXXXXX even after treatment is complete. This is just like a cut wound on your skin which has healed a long time back but the scar is still seen.

Coming to your query on curative treatment of TB, you are right in saying that it is one of the tough bacteria and treatment for at least upto a year may be required in most patients. TB can affect any part of the body from head to toe. Since TB is commonly associated with chest infection, common people are not aware of this fact. Rigorous treatment is the first step towards treatment of TB. Subsequently, patient education and healthy living are stressed upon. TB germs are present in most communities and almost all of us are exposed to that. It is only the weak and people with immunocompromised status who show disease manifestations. Since Chest TB in chest can co exist with TB anywhere else in the body, any other relevant health problem may be discussed with the TB specialist and investigated if necessary. I would suggest that your wife gets used to healthy eating and takes care about regular fitness.

I am sure that your wife will lead a normal life once cured. In my own personal experience, I have met many people (including staff in medical jobs) who had the disease and are now completely treated and leading fit and healthy lives.

Hope your query is answered.
If you do not have any questions, I request you to please close this thread and post a feedback.

Let us hope for the best.
Wishing your wife good health.

Regards,
Dr Vivek

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Hi Mr XXXXX,
You are most welcome and thank you as well.

Hope I have been able to answer your queries.
Hoping for the best.

Regards
Dr Vivek

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Hi Mr.XXXXX,
Thanks for writing in with CT scan chest report details.

Please do not hesitate to clear your smallest doubts.

I will explain the entire report pointwise to the best of my ability:

1)     Patchy fibrotic changes are seen in the apical and posterior segments of right upper lobe with associated parenchymal architectural distortion and traction bronchiectasis.

This is related to findings which say that the affected upper lobe areas of the right lung are now seen as fibrosis. Fibrosis in lungs is a term used to describe scarred lung tissue while parenchymal architectural distortion denotes lung tissue structural damage and traction bronchiectasis is widening of the tiny pipes in the lung that carry air within different areas of the lung. All these findings are irreversible and will remain that way.

2)     Lung fields are otherwise normal in attenuation and show normal bronchovascular markings. No active parenchymal lesion is seen. No centrilobular nodules or consolidation is seen.

These findings describe that the rest of the lung tissue is normal. No tuberculosis or any infective activity is seen in the lungs. If this is understood clearly, it means the changes under 1) above are not so significant when we take the whole lung into picture.

3)     Mediastinum is central in location. Discrete tiny to prominent mediastinal nodes are seen, few of them showing calcification.

Here the presence of small lymphnodes have been described in the space between the two lungs, few of which show calcified appearance. I would have liked if they had mentioned the size of the biggest lymph node seen but any ways what is written suggests healed (inactive) lymphnodes. The healed mediastinal lymphnodes subsequently get totally calcified in most TB patients.

4)     Trachea and major bronchi are normal in caliber. No intraluminal filing defect is seen. Both hila are normal in size and configuration. Hemidiaphragms are normal in position and reveal no significant abnormality.

Appearance of major airways and diaphragms is described. These findings are completely normal.

5)     No obvious plural or pericardial effusion is seen.

No abnormal water or fluid collection is present in the space around the lung or heart.

6)     Bones do not show obvious abnormality in the sections under review. The muscles and soft tissues of the chest wall do not reveal abnormality.

The bones and muscles of the chest are normal.

7)     Visualized sections through the upper abdomen reveal mild hepatosplenomegaly.

The liver and spleen (organs in the abdomen) appear slightly enlarged.


Impression mentions past tuberculosis changes in right lung, top part. No active infection is seen at present.

Coming to your queries:

1.     For point number 1, as you 've said in your previous answer, the patients who undergoes through chest TB are left with scarred lungs and development of fibrosis.I am worried, will this fibrosis will lead to more acute problems in future of my wife such as difficulty in breathing,weakness, pneumonia or repeated infection etc. Does it lead to fibrosis inflammation in future or is it cancerous. I also want to know if a person have fibrosis can this be cured or healed completely or 'll it remain throughout the lifetime. Does it effect the life expectancy of one?( I got in some forums in internet that it reduces the life of a person).

Fibrosis is some sort of not fully functional lung tissue and does not allow much gas exchance. There is a possibility of secondary infection or re infection occurring in those areas in future. Please remember that this is only a rare event and will not occur if your wife takes prompt medical attention for any chest infection in the future. The fibrosis itself is healed scar. Very rarely can a scar in the lung transform into a tumor (I am still to see such a patient in my 10 years of practice). By affecting life expectancy, the forums must have meant the predisposition to secondary infections and thereby the need for regular medical care, which if delayed or ignored, can lead to a relatively decrease in quality of life. Let me assure you that those are in the books and need not occur with your wife.

2.     For point 3, if I am not wrong, is calcification of mediastinal nodes, means making the nodes inactive. Will it effect her if present or should it be removed through some treatment?

There is no need of getting them removed. They can be left there. There are plenty of lymphnodes in that region. For the time being you could ignore that. If a CT is done after let us say 5 years, the size and number can be compared to check for any new development, which is again less likely to happen.

3.     For point 7, can this enlargement be treated or will it become normal gradually?

This concerns the liver and spleen. It may require an ultrasound scan abdomen for confirmation and subsequent assessment by liver function tests. Spleen enlargement is mostly associated with infections keeping the problems faced by your wife in mind. The cause of liver enlargement can be better assessed through liver function tests of blood. This may have to do more with her general health than tuberculosis history.

Hope I have answered your queries.
Please feel free to ask any further questions.

Regards
Dr Vivek

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Hi Mr.XXXXX,
Welcome and thanks for writing in again.

I would like to clarify that the function of the area of lung having fibrosis is compensated by the rest of the lung which is normal. Hence there is no significant functional deficit in gas exchange in the lungs.

Please do discuss point 7) hepatosplenomegaly in detail with the TB specialist and if required have a consultation with the XXXXXXX medicine specialist or gastroenterologist.

Let me explain in short about the medicines prescribed.
1.     Signo Flam: This is a pain killer combination of aceclofenac and paracetamol and given for pain relief.
2.     Raxclav: I could not find Raxclav in Indian list of medicines. Instead there is Taxclav (please re confirm name) in India which contains cefixime and clavulanate Potassium and is an antibiotic preparation.
3.     Rabifast: This is rabeprazole which is a medicine to decrease stomach acidity.
4.     Allegra: This is fexofenadine and used as an anti allergic.

Your doctor has tried to take care of all possibilities towards cough, cold and fever. It could also have been a viral infection but then its always good to start on antibiotics to control any secondary infection because your wife has suffered from tuberculosis. The chest pain your wife is occasionally complaining could be because she is weak after the recent chest infection and may be due to repeated coughing.

It may be important to note that right now we are having monsoon and regular rains and that must be happening in Assam also. As a result I have come across many patients who are suffering from viral respiratory infections.

Hope I have answered your queries.
Please feel free to ask any further questions.

Regards
Dr Vivek

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Dear Mr XXXXX,

Thanks for your faith in me and this website.
We are always ready to answer your questions.

Wishing you and your family the best of health.

Regards
Dr Vivek

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