Q. My wife is having bilateral pneumothorax and mediastinal emphysema. Please suggest.

Answered by
Dr. Amolkumar W Diwan
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Feb 13, 2020

Hi doctor,

I am looking for a specialist in pulmonology. My wife has been diagnosed with pulmonary fibrosis. She is having a small rim of pneumothoraces bilaterally with subcutaneous disease and mediastinal emphysema. I am attaching here her medical test reports for review by a specialist who can suggest a treatment to manage this condition.



Welcome to icliniq.com.

I have gone through all CT scan reports and images. (attachment removed to protect patient identity).

It looks like this is a long-standing problem and it is progressing as well. But, unfortunately, there is no mention of the chief complaints of the patient and no previous treatment details are available. Before we plan any treatment, it is very important to review previous medicines and see if there was an improvement or not.

As per CT scan, it looks like to be NSIP (nonspecific interstitial pneumonia), a chronic type of interstitial lung disease. Also, it is complicating as leakage of air surrounding the lungs and heart. It is very important to see what is the oxygenation status of the patient and other comorbidities.

The treatment of NSIP mainly consists of steroids as per the weight. If oxygen saturation is not maintained above 92% on room air, oxygen supplementation either by cylinder, concentrator or NIV (non-invasive ventilation) must be considered. So it is advisable to see a specialist pulmonologist near to you and take medicines and other required treatment under his observation as it has to be reviewed frequently according to the condition of the patient.

If the patient is suffering from any other comorbid autoimmune disease, it should be treated simultaneously. Then only the lung pathology will be under control.

I hope I have elaborated the treatment plan in detail for you.

The Probable causes:

Autoimmune ILD (interstitial lung disease).

Differential diagnosis:

Idiopathic pulmonary fibrosis.

Probable diagnosis:

NSIP (nonspecific interstitial pneumonia).

Treatment plan:

Steroids like tablet Medrol (Methylprednisolone) as per the weight of the patient. Supportive treatment as required. Oxygen supplementation.

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