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Lung diseases

Lung scars

06/22/2009

Question:

I had open heart surgery 3 years ago and recently have been coughing and out of breath from walking. A doctor prescribed a cat scan without contrast and said that scars have formed on my lungs due to the long surgery. (10 hours) He said that there is no treatment and I should return in 6 months for another cat scan, this time with contrast. Should I seek a second opinion or wait out the 6 month period?

Answer:

After open heart surgery, there is frequently some blood that accumulates in the space around the lungs (called the pleural space). As a result, tubes are placed to drain this blood so that it does not cause scar tissue around the lungs. These are usually removed within a couple of days. It is unusual for people to have coughing and shortness of breath as a result of prior heart surgery. Not knowing the details of your surgery, it is difficult to comment on it. I would also consider it unusual for you to have these symptoms appear 3 years after our surgery (rather than immediately after it). I am uncertain how a contrast-enhanced CT scan would improve the usefulness of the scan. Additional testing, such as breathing function tests and a detailed history and physical exam might reveal other reasons for your symptoms (or confirm that you have "restrictive" lung disease from pleural scarring). In patients with pleural scarring, surgeons can sometimes perform a procedure called "pleural stripping" which seeks to remove the scar tissue. I think a second opinion would be a reasonable approach to helping you with your problem.

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Response by:

James M O'Brien, Jr, MD James M O'Brien, Jr, MD
Former Associate Professor
Pulmonary and Critical Care Medicine
College of Medicine
The Ohio State University