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- Tue Apr 18, 2006 1:08 pm
My sister is 39 yrs old. She has had a dry cough for about 4 months now. She finally went to the doctor and they took a chest xray. They said the upper part of her lungs looked like cobwebs? The ordered her to have a biopsy and it was done today. The results wont be back until Friday or Monday. She has smoked on and off but never a heavy smoker. Maybe 4 a day at the most. She has been quit now for about 6 mths. All the doctor said was it wasn't pneumonia and there wasn't a large mass. What could this be?
| Dr. A. De la Guerra
- Mon Apr 24, 2006 10:53 pm
Sorry for not answering earlier. Cough persisting for more than 3 weeks is called chronic cough, and might be due to more than one cause simultaneously. Cough related to cigarette smoking should significantly improve or disappear within 4 weeks after quitting smoking. Doctors take into consideration two important items when looking for the origins of chronic cough: patient’s smoking history and the chest x-ray (CXR) findings. In nonsmokers who have normal CXR, chronic cough is likely due to postnasal drip syndrome (e.g. runny nose), asthma, and/or gastroesophageal reflux disease, nearly 100% of the time.
Common causes of chronic cough in smokers are chronic bronchitis and lung cancer. Chronic bronchitis is characterized by the production of phlegm with the cough most days of the week (diagnosis is established when lasts 3 months or more in at least 2 consecutive years). Even though lung cancer is a rare cause of chronic cough (less than 5% of all cases), it should be rule out in adults with persistent cough, particularly in current or former smokers. Usually, when CXR findings are abnormal, a biopsy is necessary to exclude cancer. Certainly, there are hundreds of other causes of cough, but are less common.
About the CXR findings, as you can imagine it’s very hard for me to assess, neither interpret the films over the internet. Although, I will attempt to make a general analysis, based on your descriptions, for which I will assume that by cobwebs the doctor meant fibrosis. Pulmonary fibrosis is a consequence of many types of lung diseases, in particular chronic inflammatory ones; normal lung tissue is converted to scarred tissue, called fibrotic tissue. Most common causes of bilateral upper lung lobe fibrosis are old tuberculosis and non-specific fibrous scarring (not known cause). Additional causes of localized lung fibrosis include previous bacterial (e.g., pneumonia) or fungal (e.g., valley fever fungus) lung infections. Localized fibrosis could also be due to sarcoidosis, pneumoconioses (mineral lung deposits), histiocytosis X, and ankylosing spondylitis.
I hope you find this information useful.
Dr. Alberto de la Guerra.