Chest Xray

[old] debs · Post by **[old] debs** » August 25th, 2004, 5:46 pm

OK - I went in for an annual physical about 1.5 weeks ago All my bloodwork looks great - CRP and cholesterol etc were good Due to a very strong family history of lung and heart trouble, my doc had me get a chest xray as part of the physical My physician's assistant called on Monday. She said my chest xray appeared to show emphysema.. But she also said if I took a very big breath before the chest xray, the xray might look as if I might have emphysema. Of course the xray tech tells you to take a big breath before she takes the xray. Are there any docs in here that can help me to understand? Why would taking a very big breath before an xray make it look like you have emphysema? And why wouldn't all chest xrays look like you had emphysema since we all take a big breath before the xray is taken? Anyway I am supposed to be going for either a 2-view chest xray or for a ct scan to find out more.. in the meantime I'm certainly curious I am not a smoker - tho I spent the 1st 18 years of my life in a very very small house with 2 to 3 chain smokers. I noticed that sometimes emphysema might be caused by some type of protein deficiency - but that is very rare Thanks for the help

[old] JRBJR · Post by **[old] JRBJR** » August 29th, 2004, 2:21 am

debs, I can understand your confusion and concern. Is the PA suggesting some other method besides a chest X-ray for confirming or ruling out emphysema? At this point, you're definitely owed an expert and informed opinion, not just idle speculation from your PA. Here's hoping it all turns out to be nothing.

[old] kamdo · Post by **[old] kamdo** » August 29th, 2004, 7:50 am

debs, Did you get an "official" x-ray report yet, or was this just the PA's preliminary opinion? This is important. Many times, non-physicians give a preliminary report that is later amended by the attending radiologist. Emphysema is generally diagnosed by a combination of symptoms, chest x-ray findings, and physiologic parameters like pulmonary function testing (PFT's). You are correct that there is an enzyme deficiency that can cause emphysema (alpha 1 anti-trypsin), but this is fairly rare. Most cases are obviously caused by years of smoking. To answer your question regarding the chest x-ray (CXR) technique, you have to understand the usual findings on an x-ray of an emphysema patient. They are the following: - Flattened diaphragms from hyperinflation - these patients have air-trapping from damaged alveoli, and their baseline CXR shows these signs. - Elongated cardiac silhouette - basically everything on the CXR seems "stretched out" and the heart border seems "skinny" and elongated. - Hyperinflation - the entire top to bottom lung volume seems larger than usual since there is air-trapping. This is essentially the cause of item #1 above. - air-trapping behind the sternum on the lateral CXR. So if a person takes an exceptionally deep breath like fit individuals are able to do, they essentially increase the lung volume top to bottom and cause normal (expected) flattening of the diaphragms. To a trained physician, this should be easily distinguishable from emphysema. This is why radiology techs and non-physician staff shouldn't be giving preliminary reports to patients. I take it you have no symptoms like shortness of breath on mild exertion, frequent cough, wheezing, etc? My advice...wait for the official CXR report, and if there are still concerns for possible emphysema, see your family MD who can order PFT's. If you have none of these symtoms mentioned above, and you can erg/workout hard without problems, then I wouldn't get overly concerned. kamdo Emergency Medicine Physician

[old] debs · Post by **[old] debs** » August 29th, 2004, 11:00 am

Kamdo - You are a wealth of information! Upon another PA phone call, I asked her exactly what she saw that made her suspect potential emphysema. She mentioned hyperinflation (as you did), and she said there were a few vessels that appeared to possibly be slightly engorged I did get a pulmonary function test scheduled for September 10th - so that will be the tell-tell sign. I'll be glad to find out for sure I don't have shortness of breath during *mild* extertion, I've never smoked for one month (tho I did live with second-hand smoke growing up), and as a white-collar worker I've not worked near chemicals I wonder if all my cardio exercise might have helped my deep breath look odd on an xray, as ya suggest. For the past few months I've been doing intervals twice a week and thus breathing quite hard like a mad woman. I did get a little concerned cause I read of symptoms of the enzyme deficiency and I have a few of them (year round allergies and dry mouth) but most of the deficiencies I do *not* have Thanks - I'll post in a couple of weeks after the PF test Deb

[old] kamdo · Post by **[old] kamdo** » August 29th, 2004, 12:17 pm

deb, My pleasure. Hope things turn out well. Remember, back in the 1930's (I believe that was the decade), a marathoner named Clarence DeMar won several Boston Marathons in a row. Doctors determined he had an "enlarged" heart (would be considered normal today) and recommended that he stop running. I don't recall all the details without a reference book in front of me, but he apparently did stop running for awhile, then said "screw it" and won Boston a couple more times! Good luck! kamdo

[old] Bayko · Post by **[old] Bayko** » August 30th, 2004, 6:23 am

Kamdo, In 1911 Clarence DeMar was warned by the doctors to not run the Boston Maraton because of a heart murmmer (as well as the ol' enlarged heart). He ran it anyway and won, THEN took their advice and missed the next 10 years. Prime years. He took it back up again around 1921 and won it six more times. When he died of cancer in his 70's, having continued to run the marathon right to the end, an autopsy showed the heart of a man half his age. Rick

[old] kamdo · Post by **[old] kamdo** » August 30th, 2004, 6:52 am

Rick, Thanks for the clarification on dates and facts. I got the jist of the story correct but couldn't remember all the details without a reference in front of me. The point that I was making was that "normal" findings in athletes may appear abnormal to someone not used to dealing with healthy and fit people. kamdo (Kevin)

[old] kimchitom · Post by **[old] kimchitom** » August 30th, 2004, 7:41 am

Kamdo said, "normal findings in athletes may appear abnormal to someone not used to dealing with healthy and fit people." (tried to copy Kamdo's statement but was outwitted by the compter.") I got a big laugh out of it as Kamdo reminded me of an episode that occured about 40 years ago. I was an amateur bicycle road racer in Hawaii while serving with the U. S. Marines. Rode my bike to work and took an annual military physical exam. Later, I was called back to see the medical officer. "You've got a high white blood count according to your urinalysis. Report daily for a prostrate massage", sez the doc. Which, of course, I did. On the sixth day, the massager doc was unavailable. The doc I did see, knew me and my bicyle activities. "Shove off, sez he. There's no problem with you. It's normal for a bike racer to show a high white blood count in an urinanalysis conducted right after you've been riding. The seat has been massaging your prostate." Being a straight man, I went and looked for that massager doc. Fortunately for him, he had been transferred to the mainland. kimchitom, 72, lwt.

[old] kamdo · Post by **[old] kamdo** » August 30th, 2004, 8:24 am

kimchitom, Great story!! Us Docs have a bit to learn from high level athletes who have redefined optimal health, aging, and what the human body can achieve. kamdo

[old] debs · Post by **[old] debs** » September 1st, 2004, 1:02 pm

Once I was with my high school daughter at daughter's doc's office - and the doc noticed the kid's pulse was about 40. The doc said they have *very* few teens with such pulse - the only one she knew of at her office was one who was training for the olympics

[old] sekitori · Post by **[old] sekitori** » September 3rd, 2004, 2:42 pm

I agree that many MD'S don't know that much about sports induced problems. About three years ago, some microscopic blood showed up in my urine during a routine exam. I had a cystoscopy (not much fun) to see if there was anything in my bladder or urinary tract to cause it. It was negative. So was a scan to see if a kidney stone was the cause. The cause was "undetermined" but not serious. I always thought that the bleeding probably had something to do with my rowing, but my physician and the urologist didn't think so. A couple of months ago I had a routine physical exam and the microscopic blood showed up again. I had another cystoscopy (again not very enjoyable) because my physican wanted "just to be sure". I knew the result would be the same and it was. My doctor and the urologist both thought that it could be coming from irritation of capillaries of the prostate but they didn't know the cause. But they said it was nothing to be concerned about. Again I suggested that rowing could be a cause and they both didn't think so. I recently found some research papers saying that several sports, including rowing, have been known to cause hematuria in urine. I was going to show both physicians these papers, but they probably wouldn't believe them even if they saw them. The easiest way to prove that rowing is really the cause of this is to stop doing it for three or four days. All the microscopic blood cells should be gone. the only trouble is that I can't go that long without rowing. So I guess I'll never know for certain. By the way, did you know there is something called "bongo drum hematuria"? It's caused when the bladder is traumatized by pounding those drums which are held between the thighs. I guess someone who rows and also plays bongo drums should be aware of that.

[old] debs · Post by **[old] debs** » September 10th, 2004, 9:48 pm

I had the pulmonary function test this morning While the respiratory therapist is not permitted to diagnose patients, she did mention that I had 135% of the volume that would be expected for someone my size. I'll hear from my doc in a week or so Sounds like my chest x-ray made my lungs appear hyper-inflated because I'm so used to taking big gulps of air while working out

[old] JRBJR · Post by **[old] JRBJR** » September 10th, 2004, 11:31 pm

Sounds very promising, debs. There may be a valuable lesson here for those of us getting chest X-rays.

[old] kamdo · Post by **[old] kamdo** » September 11th, 2004, 7:57 am

debs, The overall lung volume is excellent, but the critical numbers you are looking for are the FEV1 (forced expiratory volume in one second). This number is one of the most important in determining your lung function. It is analagous to the peak flow meters that give a measurement of the volume of air expired in a short period of time. Both of these numbers measure restriction to flow and are prime factors helping to diagnose restrictive lung diseases like asthma and emphysema. The FEV1 should be a significant percentage of your total lung volume, ie, generally around 80-90%...this means that you can expire 80-90% of your total expiratory volume in the first second. There are several other subtle indicators of restriction to air flow, and most of the machines that perform these PFT's also can analyze these results which are also based on height and weight. Also, any pulmonologist can also offer an interpretation of results. Keep us posted. kamdo (Kevin)

[old] debs · Post by **[old] debs** » September 11th, 2004, 5:43 pm

Thanks very much for the info The respiratory therapist told me she did not see anything out of the norm - but she also made sure I understodd that she is not permitted to diagnose anything Cheers Deb

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