HRCT Scan Essay

Ron was seen today following the HRCT scan to assess for the significance of the crackles in the setting of his mild decrease in gas transfer factor. The HRCT showed multiple bilateral calcified pleural plaques consistent with his known past asbestos exposure, probably as a child, and some mild subpleural reticulation in the bi-basal regions noted, but no interstitial fibrotic change. The significance of these findings is uncertain and given that we have no past chest imaging that Ron can recall, they either represent old changes or are progressive interstitial lung disease. The reassuring thing is that his relatively well-preserved lung function tests with his normal spirometry and only mild decrease in gas transfer factor and, as such, the findings are probably incidental and unlikely to be contributing to much to his shortness of breath on exertion. Ideally, a lung biopsy would help differentiate between old versus new changes, but I don’t think that it is Ron’s best interests. As such, I will organise an autoimmune screen to make certain that there is not a connective tissue disease associated, but otherwise, we will monitor this expectantly with repeat lung function tests in two months’ time, and if these are stable, I think expectant management is the way forward with Ron. …show more content…
He has been prescribed Telnase for his nose, but unfortunately, the systemic absorption that is reasonably high with the antihistamine nasal sprays, has caused considerable??? side-effects with Ron, with blurred vision, dry mouth and worsening urinary issues. I have suggested he stop this and continue on with Nasonex for management of his nasal stuffiness. I will await Simon’s letter to help discuss further management, whether or not this is needed moving