Question about atelectasis/fibrosis - 1254111

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double trouble
Question about atelectasis/fibrosis - 1254111

I just got the copy of my PET/CT report in the mail. I knew I had some sort of a blockage to the right upper lobe from my last bronchoscopy. This PET/CT states that there has been an interval development (which I understand means during the time between this scan and the last one) of right apex (the uppermost segment of the upper lobe) atelectasis (collapse) / fibrosis (scarring).

Ok. Hopefully I'm learning the language correctly. So, since my last scan, presumably because of the blockage, the uppermost segment of my right upper lobe has deflated and developed some tissue that looks like radiation fibrosis (per the report) but isn't, since I haven't had any radiation for about a year and a half.

The questions are:

1.) Can I assume that this blockage is the source of my shortness of breath? It is just one little segment of one of three lobes. Doesn't seem like much, but I am huffing and puffing after a flight of stairs.

2.) I know that the tumor is the cause of the blockage. Can I also assume that the atelectasis/fibrosis is not likely to be reversible? Or would increasing my activity and perhaps using a spirometer help to re-inflate and restore this segment of lung?

3.) I hate the idea that a chunk of my lung, how ever small, is now useless and deteriorating. So long as there is a blood supply to the tissue there will not be necrosis, right?

Thank for your continued indulgence,
Debra

Dr West
Reply To: Question about atelectasis/fibrosis

Debra,

I think it makes sense that the blockage is contributing significantly to shortness of breath. Even if it's not a large volume of lung that isn't functioning, it could be enough to cross a threshold of lost function that makes a significant difference for you.

It's possible, however, that an interventional pulmonologist or thoracic surgeon doing a bronchoscopy could either remove tumor in the lumen (area of the tube that's supposed to be hollow) of the trachea, so-called "endoluminal disease", or place a stent across it to reinflate that area of lung and improve pulmonary function.

Finally, that area doesn't necessarily die unless the blood supply to that area is cut off. That's different from losing ventilation to that part of lung, though an area of collapsed lung is definitely prone to infection, which we call a "post-obstructive pneumonia".

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

double trouble
Reply To: Question about atelectasis/fibrosis

Thank you so much Dr. West. I could search and study for weeks and not end up with as clear a picture as the one you just provided. I am so grateful for this site and for you.

I will be particularly careful to watch for fever or other signs of infection. I will also probably make an appointment with the pulmonologist to discuss things further.

With so much love and respect,
Debra

double trouble
Reply To: Question about atelectasis/fibrosis

I thought I would use this old thread since my post and questions are related.

My entire upper lobe is now blocked. I don't think it has collapsed yet, but it probably will. The main right bronchus is narrowed to 1cm (I don't know what normal would be) and it has been determined that stenting is not an option.

It is presumed that the hilar node has grown, and is pushing against the right bronchus. OK. From that I can understand the blocked access to the right upper lobe, but what I don't understand is why the the circumference of the right main bronchus is narrowing. He called it "circumferential constriction.

The Doctor who did my bronchoscopy said he stirred up a bunch of junk in the middle and lower lobes, but it was really hard to get the lavage fluid in and out.

With waxing and waning opacities, could this be the same infectious/inflammatory process? Bronchiectasis?

I would appreciate any ideas about what may be causing this? Not looking for an internet diagnosis, just general info.

Debra

Dr West
Reply To: Question about atelectasis/fibrosis

Debra,

Honestly, I'm afraid that yours is so extremely complex a situation, and there are so many potential issues that can lead to lung opacities -- the list of possibilities is so long that it's just meaningless to wildly speculate here. If you do a google search of "etiology, lung opacity" or "causes of lung consolidation" you'll get a sense of a pretty wide range. Prior radiation is definitely a culprit of these changes, and obviously pneumonia can cause that, but there are many more potential causes.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Associate Clinical Professor
Medical Oncology
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

certain spring
Reply To: Question about atelectasis/fibrosis

Interesting question as to what the normal circumference of the (right) bronchus is supposed to be? Or does it vary from person to person?
Debra, you are most probably sick of hearing about me but let's just say that even in my good state I've got an aperture that is measured in single-digit mm. In my own (obviously particular) case the prime culprits would be infection and scar tissue. I guess asthma would be a classic non-cancerous example of airway constriction.

double trouble
Reply To: Question about atelectasis/fibrosis

Thank you cs, and I was about to ask you for an update???????

I googled around a bit but never did find a "normal" size.

It seems to me that only the hilar node is malignant and causing problems for the upper lobe, but that the waxing and waning opacities, and the bronchial constriction are something else. I don't see how more radiation will help there, so I guess I'm heading back to pulmonary. I'm wondering if cautery or cryo are options to bore out the airways. And to me it seems that doing lavage 3 times is a bit much, but it did jar some of the mucus loose and I'm breathing a bit better. I think the results that were negative the previous two time are still going to be negative.

I will see the rad. onc. in a couple of hours. Hopefully he can answer some of my questions.

Debra

double trouble
Reply To: Question about atelectasis/fibrosis

Ok. Radiation Onc. thinks I can probably have 30gy more over ten fractions. I have a contrast planning CT in the morning to find out more. I took him a drawing of lungs and bronchus so he could put a circle where the node is, scaling the size to the real thing. I can see why I can't get any air. I hope this works. I will update tomorrow after I see him.

Much love,
Debra

certain spring
Reply To: Question about atelectasis/fibrosis

Sounds encouraging.

double trouble
Reply To: Question about atelectasis/fibrosis

Top 'o the Roller Coaster... Wheeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeee! Forgot to add, I will continue Zalkori through the radiation treatments. Craig, I gave him a copy of the abstract you linked me to. Thanks again.

Debra