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Ask Dr. D. Love Your Own Question

Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17681
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Hi already asked this question yesterday bug only asking again

Customer Question

Hi already asked this question yesterday bug only asking again for a different dr's opinion:
Hi can you please help withe following CTPA report, should
i be concerned about the ground glass opacity?
CT Angiogram pulmonary: No definite pulmonary artery embolus demonstrated. No mass, no consolidation and no enlarged mediastinal lymph nodes.
On review on lung windows there is some slightly increased ground-glass opacity in the posterior lower lobes which probably represents dependent change although early infection is also a possiblity.
On review on bone windows no definite destructive bone lesion is seen.
In summary no definite pulmonary embolus demonstrated.
(scan done 11th August 2014)
Submitted: 2 years ago.
Category: Medical
Expert:  Dr. D. Love replied 2 years ago.
What symptoms are you having that prompted this study?
Customer: replied 2 years ago.
I had chest pain and then a raised d-Dimer test made them do a ctpa
Expert:  Dr. D. Love replied 2 years ago.
Thank you for the additional information.

You speak of the chest pain in the past tense, and if that means that the pain is no longer present, then this is probably normal.

The primary reason for doing the test is completely normal, as there is no evidence of a pulmonary embolus (blood clot in the lung).

The only finding that may be an issue is the slight ground glass appearance, which as they state could be an early infection. If the chest pain is ongoing, there would be more concern that this could be an infection, and a course of antibiotics may be appropriate. But if there are no current symptoms or other signs of infection (such as fever), then this is unlikely to be infection. Instead, the other issue that is noted is that it probably is dependent change, which means some mild fluid accumulation in the portion of the lung that is lower in the chest, due to the effect of gravity. This is not a worrisome finding and there is no reason for concern if there are no current symptoms that would be worrisome for infection.

If I can provide any further information, please let me know.
Customer: replied 2 years ago.
Ok my worry was that what if it's early signs of lung cancer, I think I read somewhere online about it .. That's what I'm panicking about.. And yes I have no symptoms what so ever apart from a slight cough but that's more in the throat area.. I was given co-amoxiclav antibiotics.. Anyway 2 months prior to this I had a CTPA at that time too.. The report at that time was:
There is normal enhancement of the pulmonary vasculature, there is no mediastinal lymphadenopathy or endobronchial lesion. there is no pleural effusion. Bilateral subtle apical pleural thickening is noted. There is no calcification. Linear subsegmental atelectasis is noted in the left base. No focal lung abnormality is seen otherwise. No focal bone abnormality. Conclusion: no PE
Customer:
do you think the subsegnemntal atelectatsis is similar to that ground glass opacity that was picked up recently?
Expert:  Dr. D. Love replied 2 years ago.
There is no reason to be concerned about cancer, because the CT scan stated that there was no masses or lymphadenopathy identified.

Yes, the ground glass appearance can be related to the prior area of atelectasis, although this report speaks of both lower lobes and the prior atelectasis was apparently only on the left side.
Customer: replied 2 years ago.
Ok but in your experiences as a dr, have you not come across lung cancer like this? Does it not start of as ground glass opacity? Is this a common finding in ct lung scans?
Expert:  Dr. D. Love replied 2 years ago.
I have had patients with a ground glass appearance on plain chest x-ray that was found to be due to lung cancer on further evaluation. But I have not had a patient with a ground glass appearance on CT scan without any suggestion of a tumor that was later found to be due to lung cancer.

A ground glass appearance is fairly common, as it can be due to a variety of other reasons that are more common than cancer.
Customer: replied 2 years ago.
So do you think I should just forget about it being lung cancer?
Expert:  Dr. D. Love replied 2 years ago.
I would not be concerned from this report. If you want reassurance, it is an option to simply repeat the test. But if this were someone in my family, my advice would still be that there is no reason for concern or further evaluation.
Customer: replied 2 years ago.
I saw a chest physician and he told me that he doesn't think it's anything serious.. He said we will do a chest ct in approx 3 months... I'm scared that if it's cancer then in 3 months it might have spread.. So are u staying that with lung cancer as well as ground glass opacity there would be other abnormalities on a ct? I recently had just a normal chest X-ray and that was clear
Expert:  Dr. D. Love replied 2 years ago.
There is no perfect test for lung cancer, but the CT scan is the best test for trying to screen for lung cancer, and is now the recommended test for persons that are considered high risk because of a significant smoking history.
Customer: replied 2 years ago.
I smoked for approx 12 years... I gave up 5 years ago
Expert:  Dr. D. Love replied 2 years ago.
You do not say how much you smoked, but that is probably not considered high risk. The recommendation for the people that should be screened with CT scans are people with a 30 pack-year history of smoking, which is usually someone who smoked one pack per day for 30 years. For someone that smoked only for 12 years, they would have needed to smoke 2½ packs of cigarettes per day to yield a 30 pack-year history of smoking.
Customer: replied 2 years ago.
I smoked approx 10 to 15 cigarettes a day... If it helps with your diagnosis, I have and was at the time of the scan coughing up white or clear phlegm.. Does this mean it's just a viral infection and I'm just worrying over nothing? Also at the time of the scan I didn't take a very deep breath so maybe my lower lungs did not fill properly? Would that cause the appearance of GGO?
Expert:  Dr. D. Love replied 2 years ago.
Cough and sputum production are more typical of an infection, but a half-hour ago, you said it was in your throat, so would not explain the changes in the lung.

The CT scan is not usually done with a deep breath, only normal breathing. The ground glass appearance is probably what we discussed above, from dependent fluid.
Customer: replied 2 years ago.
I get a feeling in my throat as though some sputum is stuck so when I try clearing it and make myself cough then that when I feel as though it comes from my lungs
Expert:  Dr. D. Love replied 2 years ago.
If it is coming from the throat, it would not cause the changes on the CT. If it is coming from the chest, then the changes could be due to infection.
Customer: replied 2 years ago.
Ok thanks... Feeling slightly better now after this chat... Was so convinced that it's lung cancer that I couldn't think straight .. The consultant who I saw at the hospital when I had the scan told me that it's a common finding because of high resolution scanners they pick up "noise" which doesn't really mean anything... I don't want to keep u here much longer.. So once again .. In your years of medical practice and experience you don't believe it's lung cancer?
Expert:  Dr. D. Love replied 2 years ago.
Correct. I do not believe that it is lung cancer.
Customer: replied 2 years ago.
This is what one of the other docs on here told me yesterday:
Dr Uzair :
The report is actually self explanatory, ground glass appearance on CTPA can mean a normal appearance due to patial filling of the lungs or incomplete expiration of the lungs during the scan, other conditions that present as a ground glass appearance are edema, inflammation, infection, fibrosis, interstitial thickening and all these conditions also have clinical symptoms, which you have none.
Customer:
i have read somewhere online that it can be early signs of lung cancer, thats what was worrying me
Dr Uzair :
And the CTPA report has indicated that there is no nodule or mass seen in the Lungs and there is no area of collapse further ruling out any sinister condition in the lungs.
Dr Uzair :
Yes, the CTPA has ruled out cancer clearly.
No, I am not a UK doctor.
Customer:
ok, i went to see another dr privatelywho is a chest physician and he has 40 years experience and he as rather than on the NHS and he has said that its unlikely its cancer, he said if i was 70+ plus years of age then he would maybe investigate it. he said that i can have another CT scan in approx 3 months to check it again, do you think i need that?
Dr Uzair :
The next CT scan is for your peace of mind and not to rule anything out, since the first CT scan has clearly ruled out cancer and you do not have any symptoms. This fact has also been endorsed by your Radiologist and the experienced chest physician you saw.
Customer:
ok well i definately need the peace of mind, just a bit more info before you go, i had a CTPA approx 2 months prior to this one, and the report at that time was:
Customer:
There is normal enhancement of the pulmonary vasculature, there is no mediastinal lymphadenopathy or endobronchial lesion. there is no pleural effusion. Bilateral subtle apical pleural thickening is noted. There is no calcification. Linear subsegmental atelectasis is noted in the left base. No focal lung abnormality is seen otherwise. No focal bone abnormality. Conclusion: no PE
Customer:
do you think the subsegnemntal atelectatsis is similar to that ground glass opacity that was picked up recently?
Dr Uzair :
Yes, it could be. The ground glass appearance in your cases could be a result of residual thickening after atelectasis. However, I wouldn't sweat on both the CT reports, they do not indicate cancer nor any serious pathology you should worry about.
Customer:
the main thing is i should not worry about having cancer because that is definatley ruled out?
Dr Uzair :
Yes, the CT scan is a sensitive test to rule out cancer in the lungs and definitely ruled out.
Expert:  Dr. D. Love replied 2 years ago.
That is similar to what I said.
Customer: replied 2 years ago.
Thanks doc.. U have been brilliant.. Will definitely come to you again.. Take care
Expert:  Dr. D. Love replied 2 years ago.
You're welcome.
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17681
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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