First timer question about Patchy areas of air consolidation

@mlp44 Welcome to Mayo Connect, where patients and caregivers meet to share their health journeys and support one another.

Uninterpreted (by your doc) CT Scan results can be scary! Did you find this on your patient portal this morning? I cannot explain what is going on in your lungs because I am not your doctor, but maybe I can help ease your mind while you wait to consult with them.

Each of these findings indicate there is "something" going on in your lungs, but without context it is hard to say what. Radiologists report exactly what they see to the physician, but without context because they don't know your history.
"abnormal scan" means just that - the descriptors below are not usually present in a healthy lung.
"patchy areas of air consolidation" means some of the alveoli have joined together and are larger than normal - often seen in cases of chronic bronchitis, asthma, COPD, and other lung conditions
"additional ground glass area" - scary sounding, but just means cloudy areas that cannot be seen clearly. This often happens after a bacterial or viral infection - some of the old infectious material is left behind, and usually gets absorbed and eliminated over time. Many people who had Covid had these areas, some of them very large, and they have gone away.
"secondary to multifocal pneumonia ..all right middle lobe" means there were multiple pockets of pneumonia on that part of your lung.
"can't exclude neoplastic process" - that sounds scary, because it CAN mean abnormal cell growth (benign or cancerous) But hear it means that with everything else going on, they can't see the entire lung clearly right now. That usually means they will repeat the CT, possibly with dye for better contrast, once the pneumonia is cleared up.

Was this ordered in hospital or by your primary provider?

If I were you, I would call the ordering doctor for information today so you don't have to worry through the holiday. My guess is you will be seeing a pulmonologist soon to get a clear explanation.

I hope this eases your mind a bit. Please feel free to reply here and we'll help you through this.
Sue

Hello @mlp44. I combined your discussions on lung consolidation and listed the one discussion in the Lung Health and Lung Cancer groups so members who respond will do so in one place.

@sueinmn asks a good question, will you be seeing a pulmonologist or other expert to get a clearer picture of your lung health moving into the new year?

yes, consolidation (all white) and ground glass (white nebula) opacities is often seen
after infection , when there is fluid or cells in the alveoli.
It usually resolves after weeks/months.
It usually isn't nodular (but can be) so
it can be some material, mucous or liqid tumor or cancer.

You can search google-scholar use a search-engine and search images for these keywords
and compare with your images.
(If they gave you a CD and you can look at the images)

Hi Sue
Thank you !!
I agree I need to talk to a pulmonologist before any type.of next step, which I havent done. My ENT basically said this is out of his realm. He can speculate and said an infection would make sense because of inflammations, chronic sinusitis, paranasal disease etc
but of course I understand that's not how medicine works. Doctors go off of proof w imaging and labs and especially in their specialty area.

My Sputum was off colored as recent as Dec 10 and Sinus CT Dec 8 confirmed chronic sinusitis and paranasal disease. Sputum is still very thick. Maybe that's the definition of sputnum???
I had larynx scoped in Oct and maxillary was full of pus especially on right but not sure if that is my right or hers? But sinuses were a mess and it went to upper resp infection. I was wheezing pretty bad.f

for a solid month at minimum. Even though my wbcs run on lower end I don't get sick often to be honest. That's weird?

My PCP said he will put me on a strong antibiotic starting tomorrow, the name starts with an L. The last time I was on an antibiotics, twice for the chronic sinusitis and URI, in October, I drank pretty heavily the whole time during both. The ENT gave me an initial rd of antibiotics that didnt touch it. Then the next rd was something stronger, a macroglide, a few weeks later and it seemed to quell it to where the wheezing stopped. I may have missed a day taking them too that 2nd rd.

Anyway, they'll do a scan after this rd of antibiotics. PCP will.refer me to a Pulm. Prob end up w the bronchscope which scares me. I have to get the Chest ct.images to Pulm too.
I am anxious to see what a pulm will say.
This started w a mediastinal node ("pre tracheal para region"that measured 1.6 on Neck Scan. ENT viewed that image of that node and said the shape and hilum? looked normal.as well as two.cervicals that were 1.5. ENT said Chest Scan referall was not urgent or STAT but should do it per radiologist.
Chest.CT references a pretracheal node 1.0 that looked "reactive"
My cbc w differential was all in normal range except absolute lymphocytes were just below normal range (.94). Neutrophils were high (72) and barely.within normal.range. NRBC were zero. I checked old labs from few yrs ago and absolute Lcytes were low then but just a little higher (1.20) My pcp.said my wbc has tended to run on lower side. Maybe alcohol induced? I had a hematologist look at me few yrs back when wbc went to 2.8. He said alcohol and vitamin B12 deficiency?
Most recent WBC were back in normal range just on lower end.

I was a daily heavy drinker for years until this all started. I am using this to make a serious change. I just pray it is something I can get through to really enjoy max benefits.
I.dont know if any of this indirectly can be associated with alcohol. I am seeing inflammation as a recurring problem.
I Drank r wine and beer daily, usually in a short pd of time before bed to wind down. Bad habit I know.
Another bit of info is I have severe OSA. I didn't do a good job of cleaning cpap either. Bad habit I know.
I had an upper GI as well mid Oct and had gastritis and candidas (Dr said from antibiotics)
Your reply meant the world. I tend to.go.worst case scenario and can't see things in actuality.
I have done enough Looking to know nodules can be common, especially with lung infections. The last thing my ENT said was perhaps my upper respiratory infection settled into lower respiratory and has just been festering even though my wheezing is gone?? I am just speculating again, so I will stop. I just try to convince myself there's hope. I have already started researching cancer facilities, etc ..I know bad habit.

I have rambled on. I thank you for this forum and being able to get things out.
Thank you again.

You're doing a great job of figuring out how all of this is interconnected!
I wish you well on reducing or ending your alcohol consumption - heavy use surely doesn't help ones body to fight infection.

Many of us find all of these sinus, trachea and lung issues are interconnected - you have the ball rolling by treating your sinuses now - by the way the need for repeated rounds of antibiotics is not unusual, most are not prescribed for long enough to get rid of the entire problem. Did the ENT take a nasal swab and culture it to see what is infecting your sinuses?

I'm not a doctor, but I think your ENT was on the right track when he said the sinus infection might have also moved into your lungs. Clearing that up might clear up the lungs too.

Once you see the pulmonologist, be sure they access to all the records for this long episode. They may want a sputum sample from you to see what infection is in your lungs, and make sure the antibiotics you are taking will cure it. If you produce sputum, it might be premature to do a bronchoscopy at this point - but they may go for another CT or PET scan to give them better pictures, and to see whether things are improving with all the antibiotics.

And ooh, a dirty CPAP can cause a host of infections! I had a friend who had repeated pneumonia until I figured out he wasn't cleaning it. Can you look up the sanitizing instructions for your machine? Try to get one of your docs to order new hoses, mask, etc and throw the old ones away. Then sanitize the machine, get some new distilled water, and start over - vowing to clean the mask and dry the hose EVERY day until all of you infections are
gone.

Finally, as you have learned, antibiotics can wreak havoc with your gut - it might help to take a daily probiotic to reintroduce good bacteria to your intestines.

It sounds like you are getting on a good path - do you have anyone to support you on this journey?

I will. I am waiting and anxious. Started taking Doxycycline so maybe I will.get in quickly just to consult, then get ct.
Thank you

Sue this is timeline
1st appt ENT Sept 30
-Scoped and Sinusitis detected
- upper and lower respiratory complaints
-restriction with exhalation
-raspy voice
-Augmentin prescribed

Oct 8
CXR clear

Oct 16
-EGD
-Gastritis
-Fungal infection in esophagus

Nov 4
-2nd appt ENT
-scoped
- has felt more sick including congestion, nasal drainage, cough, and postnasal drip
- "questionable decreased breathing sounds in lower right lobe"
-nasal mucosa severely edematous
-discolored green micropus in Ostealmeatal Complexes extending into posterior pharnyx
- thickened mucopus adherent to the adenoid bed and posterior pharyngeal wall.
-Biaxin prescribed for infection

Dec 8
Neck CT 12/8
- Swollen pretracheal paratracheal node 1.6

Sinus CT 12/8
-Paranasal sinus mucosal disease.
-Right maxillary sinus retention cyst versus polyp
-There is mural thickening of bilateral maxillary sinuses right more
than left as well as the sphenoid sinus consistent with chronic
sinusitis
-There is paranasal sinus mucosal disease within bilateral maxillary, sphenoid, ethmoid, and frontal sinuses. There is a right maxillary sinus retention cyst versus polyp.

Dec 26
Chest CT
Patchy areas of airspace consolidation in the right middle lobe,
some of which is nodular measuring up to 2.4 cm. Additional ground
glass areas of airspace consolidation in the right middle lobe.
Findings secondary to multifocal pneumonia, although difficult to
exclude a neoplastic process. In the absence of infectious symptoms,
recommend further evaluation with PET/CT and/or pathologic sampling.
Otherwise, recommend follow-up CT scan in 3 months after appropriate
medical therapy for pneumonia.

Other Conditions

-Severe Obstructive Sleep Apnea
-GERD
-Heavy Drinker until 12/10
- Chronically Vitamin D deficient

Great summary - what does the ENT say about the exact bacteria in your sinuses?
Do you have a pulmonology consult set up yet? Can you set it up yourself if the ENT isn't pushing things along?
How are you doing with the doxycycline?

She never took a culture.
I am starting to reach out to get in anywhere asap.
The antibiotic is going good about halfway done. Staying on schedule. Are there things I should notice? My Sputum is not as thick and discolored.

The anxiety can be unbearable but it will subside, then kick back up.
No one can give me absolute answers except a Dr but just looking for info that will reassure me.
Looking at my info I noticed that the PA noted decreased breathing sounds in my right lung. Thinking now, with all the other infections observes, mucopus, etc..could that have been pneumonia?

Just wanting to know if it's possible this is just a previous nasty pneumonia and I'm just on the mend.