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Forum Name: Miscellaneous Chest Diseases

Question: undiagonosed breathing problem ct, xray, echo performed


 playafade - Mon Jun 20, 2005 12:48 am

Hi, thank you in advance for your time. I am frustrated by lack of diagnosis and would appreciate any quidance and "guesswork' as to diagnosis.

History: In the first week of Nov. I had a fever and cough. It was diagnosed as pneumonia. The fever subsided but cough continued. The cough continued through out the month of Dec leading my PCP to refer to pulmonologist. The pulmonologist tested me for asthma with metholcoline (sp?) response test. I reacted at 19percent. The Dr. said this was not quite the threshold for asthma (i had been on predisone the week before). The pulmonologist/Dr.referred me for ct scan, eventhough, each x ray (4) were clear except for the first one ("whcih was of poor quality"-Dr.). In early Jan. the Dr. called in to hear the ct report and said he was not concerned but there was something found in the upper lobe, a very small something (can't remember his exact words). He believed it was probably a sign from the pneumonia, but he had some suspicion of TB. He said he would review the actual ct scan results and call me if he beleived I needed further testing. I never heard from him. I went along still coughing once or twice a day, but figured things were ok and would resolve.

In first week of June I went back to the pulmonolgist with shortness of breath, mostly upon exertion, and coughing (2-3 times a day, and possibly once at night). My coughing has most always produced a white sputum. The reason i went to see him is the shortness of breath in the recent weeks and a couple of times at night I woke up wheezing (expiration) and coughing with difficult breathing-this seems to be aided/resolved with albuterol. Anyway, the pulmonologist ordered an xray whcih was clear then scheduled an echo. The echo was normal. He ruled out TB saying that it would have shown up on hte xray now if it was what caused the tree-in-bud ct scan finding. I subsequently was tested for TB on my own - just in case. It was negative. So now I am still without a diagnosis and spent a two or three thousand on testing with no diagnosis. He has given me some Advair in case I do have asthma, but it seems to have little impact on shortness of breath.

-I am: 6ft1, 400lbs
-I take: prilosec, synthroid
-My oxygen level is always 99=100 on the thingy they put on your finger for the reading
-My blood work has been "unremarkable" during all of this.
-I don't have a fever.
-No night sweats.
-The pilosec has helped indigestion immensely, however my shortness of breath persists.
-I still feel like if there is something infectious that it is in my right side. I don't have pain, I just sense something is there.
-non-smoker (use smokeless tobacco though)
- blood pressure is usually suprisingly OK 125/80
- I am being referred for sleep apnea testing, but the only real symptom of suspicion in unrestful sleep - I am not overly sleepy during the day.


I am sure I forgot somethign. Please ask if you need further info. to assist.

Questions:
1. What would you suspect is causing these shortness of breah symptoms?
2. What/who should i do/see next?
3. Does a clear xray in June rule out any infectious cause of the Dec. CT scan result?


thanks again for any guidance!
 playafade - Thu Jun 23, 2005 8:31 pm

no thoughts?
 playafade - Sun Jun 26, 2005 8:15 pm

:?:
 Dr. J. Jennings - Thu Jul 07, 2005 6:34 pm

If you don't smoke and you have a normal cxr (which is basically like your xray), the 2 most lilkely diagnoses is asthma or refux (from the stomach, for which you re on protonix). The other cause of your symptoms is post-nasal drip. These three diagnoses (drip, reflux, asthma) account for 92% of ALL COUGH in nonsmokers with a normal chest xray!
The fact that you wake up at NIGHT with shortness of breath makes asthma very high on the list. Also, many people with astham have cough as the only symptom. I would take the advair but you need to take it twice a day - you will not notice much for at least the first week or 2, but keep taking it religiously. If there is no effect at all after a few weeks, it may be the refux. You can go to twice a day for the protonix (or prilosec) or you can get a test called a 24-hour pH monitor to really nail down the diagnosis.
If you have pot-nasal drip, a steroid inhaler (like flonase) is a must - and will clear it up in a week.
The meth challenge of 19% is POSITIVE. All you need is a 12-15% change for the test to be considered positive. It would also be useful to know how many doses of methcholine it took before your irways reated t 19%.
 playafade - Wed Jul 20, 2005 8:40 pm

Dr. J,

It was the reflux. I took the protonix and it finally did away with the cought. The shortness of breath was probably some anxiety, as it has passed too. Thank you so much for time, thoughtful response and just being nice enough to give free advice to a stranger. Many thanks! Bless you.

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