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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 and last reviewed on: Mar 13, 2021

Hi doctor,

I am looking for a specialist opinion. My wife is diagnosed with pulmonary fibrosis. She has a small rim of pneumothoraces bilaterally with subcutaneous disease and mediastinal emphysema. I am attaching her reports. Kindly suggest a treatment to manage the condition.

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#

Hi,

Welcome to icliniq.com.

I have gone through the CT scan reports and images (attachment removed to protect patient identity). It seems to be a long-standing problem and it progresses fast. You have not mentioned the chief complaints of the patient and previous treatment details. According to the CT (computed tomography) scan, it looks like NSIP (nonspecific interstitial pneumonia) and it is a chronic type of interstitial lung disease. It gets complicated when there is leakage of air in the lungs and heart. It is important to know the oxygenation status of the patient and other comorbidities.

This condition is treated by taking steroids as per the weight. If the oxygen saturation is not above 92% on room air, then oxygen supplementation is given either by cylinder, concentrator, or NIV (non-invasive ventilation). So it is advisable to consult a pulmonologist to take medicines and other treatments under his observation. If the patient has any other autoimmune diseases, then it should be treated simultaneously.


The Probable causes:

Your wife is having autoimmune ILD (interstitial lung disease).

Differential diagnosis:

Your wife seems to have Idiopathic pulmonary fibrosis.

Probable diagnosis:

Your wife has NSIP (nonspecific interstitial pneumonia).

Treatment plan:

She can take tablet Medrol (Methylprednisolone) as per the weight. In severe cases, oxygen supplementation is needed.

Thank you doctor,

My wife is 62 years old. Before two and a half years ago, she got a breathing problem while walking. We consulted a pulmonologist. The doctor advised her to do some tests including HRCT and I have attached it. She was prescribed with tablet Deltacortril and tablet Cellcept. During her treatment, the doctor conducted some pulmonary function tests. After few days, she got recovery and continued to have a normal life. After a year, she started to have breathing problems again.

After that, she did a pulmonary function test and it does not show any abnormal results. This situation got serious and we consulted another pulmonologist. After consulting him, we did an HRCT and he changed some medicines. After taking it, she was comfortable with her breathing and her average oxygen status was about 95% on room air without the support of an oxygen cylinder or concentrator. She does not have diabetes, allergy, or hypertension. She does not have smoking and drinking habits. Currently, she has a weight of 55 kilograms and a height of five feet. I have attached the reports.

#

Hi,

Welcome back to icliniq.com.

On going through the CT scan reports and previous reports, it is clear that she is suffering from chronic lung fibrosis. There is no cure for this disease but we can control the symptoms by taking medicines. She was taking tablet Cellcept (Mycophenolate mofetil) and tablet Amyron. Due to disease progression, the effects of medicine gone down and her symptoms got worse. In this condition, it is good to consult a pulmonologist and she can take tablet Pirfenex 150 mg (Pirfenidone). It helps a lot. It is necessary to monitor her liver function tests after taking tablet Pirfenex. Instead of tablet Deltacortil, it can be replaced with tablet Medrol 32 mg (Methylprednisolone) in tapering doses. She can continue taking other medicines along with it. Oxygen has to be supplemented according to the oxygen saturation.


The Probable causes:

Your wife is having an autoimmune or connective tissue disease.

Investigations to be done:

She needs to do liver function tests as required.

Treatment plan:

She can take tablet Pirfenex 150 mg (Pirfenidone) and tablet Medrol 32 mg (Methylprednisolone) on tapering doses. She needs oxygen supplementation.


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