Thank you very much for referring Glenys along for further investigation of the abnormalities detected on the CT scan of her chest which was done for investigation of night sweats. As you have mentioned, she has seronegative rheumatoid arthritis for which she is normally on prednisolone, methotrexate and Arava, but the methotrexate and Arava have been stopped recently due to an elevated liver function test.
The CT scan of her chest, abdomen and pelvis did not reveal any cause for her night sweats but did reveal the presence of mild, mid and upper lung paraseptal emphysema with some non-specific scarring in the basal segment of the right lower lobe basal lingula and anterior basal left lower lobe. There were multiple scattered small irregular cysts elsewhere throughout the lung. Alongside this, there were also two small pulmonary nodules in the right middle lobe and right lower lobe which were 3mm.
Glenys is a heavy smoker who quit one week ago, after the
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He chest was clear, peripherally there was no clubbing and she was saturating at 97% on room air. Examination of her cardiovascular system revealed soft heart sounds. I could not appreciate any murmurs and there was no evidence of cardiac failure.
Impression/Management:
The mild to moderate emphysema is an expected find with her smoking history. It appears that she seems relatively asymptomatic, but we will perform some lung function tests to see whether or not she does have underlying COPD. The pulmonary nodules are non-specific but given her smoking history, she will warrant a further CT scan in three months ' time to assess for stability. We will organise this at our next appointment.
With regards to her likely obstructive sleep apnoea, we will organise a sleep study at La Trobe Private Sleep Centre and I will see her following this with some lug function test to discuss the results and management moving