Question:

I have recently had two high resolution chest CTs, secondary to radiation treatment for breast cancer. The first was a “verification CT” to prepare for treatment, but it coincidentally showed a 6 mm solitary pulmonary nodule that required follow-up in 90 days. I had the follow-up CT with and without contrast last week. This time they (a different radiologist) said the view is unchanged but the “previously suggested nodule” appears to be part of fibrotic changes that are present in both apices, more on the right (where the `previously suggested nodule` is) than on the left. There were no recommendations for follow-up, and the radiation oncologist who sent me for the chest CT never called me. I got tired of waiting and had her receptionist fax me the report. The nurse said o.k. because it was “just some fibrosis.” Meaning, I assume, the doctor is satisfied it`s not a breast metastasis or primary lung tumor (I had no lymph node involvement and had Stage 1 breast cancer – lumpectomy last June). These chest CTs apparently appear the same taken two weeks before and one month after 33 rounds of radiation to my left chest – and the area of suspicion was on the right. So I know I didn`t get the “fibrotic changes” from radiation treatment. However, I did smoke for nearly 40 years, finally quitting three years ago. I have no symptoms other than a mild sore throat and hoarseness I developed over the course of radiation, which the radiation oncologist says could not be related. I checked that out with an ENT last week who looked at my larynx and vocal cords and said there is no evidence of malignancy, inflammation, polyps, etc. Just swollen (not red) vocal cords, which he feels may be caused by GERD, and suggested Gaviscon for six weeks. He said there was no evidence a nerve which runs from the lung to the vocal cords had been affected by the radiation. Otherwise, I have no shortness of breath, coughing, weight loss, or other symptoms. However, do the “fibrotic changes” seen on the chest CTs mean a process has begun that I should follow up? If I have pulmonary fibrosis I want to know. Or, is “blissful ignorance” actually the better way to go until symptoms show up? The unknowing is going to drive me crazy if I truly only have 5 years to live. How fast does the disease progress from changes seen on a CT scan to symptomatic and then serious? Oh, I should say I am 59 years old, am female, and I`m 5`2″ and weigh 110 pounds. Thanks for any guidance you can give me. I really do want to celebrate my breast cancer survival, but the “fibrotic changes in both apices” have thrown a wrench in my emotional recovery. At this point I`m hiding my worry from my entire family who are so happy “all the tests came back negative.” Thank you so much.

Answer:

Many conditions can cause fibrotic changes in the lung. The condition that you are expressing concern about, idiopathic pulmonary fibrosis, more commonly causes fibrotic changes in the bases (bottom part) of the lungs and not the apices (top part) of the lungs. Some of the common conditions that can cause fibrotic changes in the apices of the lung include:

• previous tuberculosis
• previous histoplasmosis
• other previous lung infections
• sarcoidosis
• and chronic hypersensitivity pneumonitis.

The best way to sort this out would be to get copies of your CT images (most radiology departments can provide these on a CD) and then get an opinion from a pulmonologist who can review your history as well as the CT images. You should also get a PPD (tuberculosis) skin test for completeness.

For more information:

Go to the Pulmonary Fibrosis health topic.