Tree-in Bud, MAC, but no Bronchiectasis

May I ask what is the definitive test for Bronchiectasis? Is it what the doc visually sees on your CT scan or is it backed up or confirmed via bloodwork? I'm just wondering if 1 radiologist can say yes it Bronchiectasis and another have a different opinion.

I really do not know. All I know is that I had two CT scans read by two separate doctors and then the pulmonologist did the bronchoscopy. Maybe the HRCT in June will show something else. I am too new to this to know that much. Maybe someone else knows.

Bronchiectasis is evident on a CT scan. A "slice" view shows widened bronchii with thickened walls, which have lost the flexibility to help force mucus out naturally. A vertical view shows widened bronchii in comparison to the normal ones in other parts of the lung. "Tree in bud" is visible just like it sounds - and those little buds are typically evidence of pockets of infection. The most severe view is of cavities - whites area in the lung where the normal spongy tissue filled with alveoli, or little air sacs - are destroyed by infection.

And yes, it is possible for 2 radiologists to have different opinions - depending on what lung views a specific CT provides, how sensitive the machine is, and even what the radiologist is looking for. Last year, I had a heart scan, and due to my position in the machine, and what the cardiologist was asking for, failed to note the bronchiectasis. When I asked why it was "missed" by radiology, the cardiologist looked closely and saw it, but the part of my lung where it is most prominent wasn't included in the scan results. His opinion - the radiologist had all of my prior CT records, knew I had BE and was being treated, and didn't think it would add anything to my heart diagnosis to mention it.

Also, I had one CT where the radiologist reported no nodules on the CT, but the pulmonologist spotted them and pointed them out to me. In that case, the pulmonologist told me "that's why at least 3 different doctors read every scan." And now AI is evaluating many scans in addition to the humans.

I have had three CT’s since last summer and radiology failed to note a 1 cm cavity on not one, not two, but all three CT’s. It came to light because the cavity was in my pulmonologist after visit notes. I asked about it after the first CT, because it wasn’t in the radiologist report, and the pulmonologist said they deferred to radiology. But then the second CT, same disconnect. I then pushed the issue with my infectious disease doctor and she said to assume the pulmonologist is always right (even though my infectious disease doctor is treating from the radiology reports). Wha?! So I raised it again with pulmonologist, asked her to speak with radiology and come to a “meeting of the minds” (honestly assuming radiology would explain why pulmonologist was incorrect, but nope). After that meeting, radiology amended third CT report to include cavity. Honestly even with multiple doctors reviewing the CT, in my case, it is still a total $&1!-show.

Oh my! I am sorry to hear that. That's why we need to be as informed as we can and our own advocate. I am glad you were persistent! What is your treatment now, may I ask?

Wow, in that the Infectious Disease doctor said "is treating from the radiology reports"
I was confused about how they decide to treat us and asked a local pulmonologist. He said CT Scan along with what is or is not showing as a MAC infection...plus how we are feeling and symptoms. I was also told by another pulmonologist's office nurse (who has appeared to be excellent in all ways) that you don't see the Infectious Disease doctor associated with the 'system' unless you have MAC infection.
Again from what we are hearing on Mayo etc. IT APPEARS, each doctor decides and has their own philosophy on what to base the type of care a patient should receive and how to go about that care (medications etc. etc.) verses a/the standard for BE and MAC infections. It also APPEARS from the answers I have received, each medical system has different guidelines.
So sorry for all you have detailed above with regard to your experience and answers from them. It is so upsetting and unsettling. I would imagine that part of all you have experienced is that they do look out for each other and don't want to step on toes. That is not always good for the patient. It APPEARS it can also get confusing if they aren't all working together, talking to each other, making a mutual decision, rather than operating individually.
Just when you think you are doing everything right to help yourself there are aspects that are somewhat out of our control and things happen, such as wrong, or lack of, communication poor attention to detail.
We have to be so alert, proactive and so smart. We have to know all that we have to look out for and ask. So very taxing.
I take it the pulmonologist is not calling the shots for how to treat?
Thanks for sharing that experience, it all helps us.
Barbara

Sue, you have me curious and wondering: " "that's why at least 3 different doctors read every scan."
Who would be the three doctors? Did he tell you, do you know.?
I guess if you consider the radiologist, pulmonologist and maybe the infectious disease doctor, or PCP.
It appears the radiologist made an assumption and knows you well and all your previous test results and knows that the cardiologist knew you had BE????
Do you know in your case who, when he said '3'?
I take it you read Bayarea58's post here and experience with three.?
Barbara

In our clinical group, 2 radiologists and the requesting doc read each one. Sometimes my cardiology practice sends their images to a cardiologist/radiologist in the affiliated Heart hospital- so actually a fourth look.

Here in Texas, the radiologist at the imaging center and one at one of the affiliated hospitals read in addition to the doc. When I took my friend to the ER at night for a fall, there was a short delay before the second guy read it, and we could see a difference - the first read an incomplete fracture of the femur head, the second read a complete, non-displaced fracture of the femur head. In any case, the result was the same- at 73 they admitted her for a partial hip replacement.

My cardiologists are also testing AI for reading scans, but say they are still not relying on it.