Atelectasis in lungs

[bluebanded goby]

Recently I had a CT scan of the abdomen to check an issue with an organ. When the report came back, it mentioned an unrelated finding, noting, "Dependent changes and atelectasis is seen in the lung bases bilaterally." I gather that atelectasis refers to the alveoli being deflated.

I'm 55, and formerly smoked as a young adult (~15 years, quit at age 35), so I assume my lungs are not pristine. Six years ago I had a spirometry test that showed my vital capacity was at normal value, but my forced mid-expiratory flow rate was 66%, and the bottom of the normal range I believe is 70%. At the time, the doctor concluded that I don't have asthma, but I did have "possible mild early pulmonary impairment." As far as I'm concerned I'm completely asymptomatic -- I don't get any shortness of breath during vigorous exercise or at any other time, and the doctor indicates my lungs sound completely clear. Since that spirometry test, I've logged several hundred dives with no adverse health consequences.

Is this new finding from the recent CT scan potentially any cause for concern as far as diving is concerned?

 

[BabyDuck]

i'm sure you'll get someone more knowledgeable around here before long, but did the original problem with your organ put you 'down' for a few days? atelectasis is usually something seen on bedrest or after a surgery & not something you walk around with. as far as i know (but that's as a pacu nurse, so that's how it's slanted), vigorous coughing and deep breathing every couple of hours for a day or so will clear it up.

 

[bluebanded goby]

Thanks for the reply. No, the CT scan wasn't done after a period of bedrest -- I just walked in off the street and they took the scan within a half hour or so. It was just an attempt to get at an odd abdominal pain that my doctors as yet have not run to ground.

I'll likely ask my doctor how significant he thinks it is, and end up taking the test results to a diving-oriented doctor (there's a good one in my town with a pulmonary emphasis). But I thought it would be interesting to get any impressions about it here first.

 

[TSandM]

It's difficult to know what the cause of the atelectasis is, but if it is due to anything obstructing any of the small airways, it would indeed have implications for diving. Such obstructions have been identified as the cause of arterial gas embolism cases in patients who were unaware that they had any pulmonary lesions.

However, atelectasis can be due to failure to clear secretions or any condition which interferes with taking a normal breath. It is seen commonly following operations where an upper abdominal or chest incision is used. It can also be seen in people with abdominal distention or massive obesity. In those types of cases, it would be of less concern.

I think it's worth talking to a physician about what the suspected cause is.

 

[bluebanded goby]

Thanks, that's interesting. My body mass index is at the upper end of the normal range, and though I tend to carry weight around the middle I don't think my abdomen is unusually distended, and I'm certainly not massively obese. So it does sound like it's worth checking with my local diving doc about.

Just to be more specific about the point I was wondering about -- I gather this is not something you would expect to see routinely in a middle-aged patient who had a history of 15 years smoking but who quit 20 years ago?

For what it's worth, the doctor who ordered the CT scan didn't even mention this to me when he gave me the results -- he only mentioned the part that pertained to the organ issue the scan was intended to help diagnose. I wouldn't have known about it if I hadn't asked him to mail me a copy of the report. As far as I know, I'm completely asymptomatic.

 

[bluebanded goby]

And if I can ask one other question -- what would "dependent changes" be in the context of the lungs? (See original post at top.) This was difficult to research via Google, since it involves common words.

 

[lulubelle]

If the doc who interpreted the results of the CT scan is not a pulmonologist, your instincts about what you need to do are correct, see a DAN recommended pulmonologist. It is indeed possible that there is still some residual damage in your lungs from the smoking. Although lung tissue can regenerate to some degree, there is likely some residual scarring. Or it could be unrelated.

The finding could be inconsequential for a non diver, but important for a diver. If it were me, I would want someone to look not only at my pulmonary function, but also at my gas exchange. I'm sure that diving is still safe for you, but you may come out of this with some new rules, information to help guide you in the mix you need to dive, etc.

I'm glad you are not symptomatic. I had this problem last fall post hospitalization and it was pretty miserable.

Good luck.

 

[cutlass]

And if I can ask one other question -- what would "dependent changes" be in the context of the lungs? (See original post at top.) This was difficult to research via Google, since it involves common words.

The term "dependent" usually refers to a position influenced by gravity; e.g. your arm hanging at your side is in the dependent position. Here, "dependent changes" refers to abnormalities in the lower lobes of the lungs; i.e. the "lung bases". In particular, opacities (white patterns or areas) were noticed which are uncharacteristic of normal lung tissue (generally darker) in the lower lobes. (Whiteness indicates higher scattering/absorption of x-rays as expected for dense tissue and fluids. Darkness indicates more pass-through as expected of hollow, gas-filled regions.)

Some degree of lung tissue damage is expected of a former (congratulations) smoker. Smoking damages both the airway passages (bronchi and bronchioles) and the terminal air-sacs (alveoli). To different degrees, accumulations of fluid (called "consolidation") are expected when scarred tissue can't clear fluids in a normal fashion.

 

[TSandM]

I'm really not sure what "dependent changes" means in this context, except that I'd expect from that phrase that the atelectasis is at the base of the lungs.

And no, one would not expect to see atelectasis in someone who had been for 15 years an ex-smoker. One would not really expect to see it even in an active smoker.

 

[bluebanded goby]

I'm sure that diving is still safe for you, but you may come out of this with some new rules, information to help guide you in the mix you need to dive, etc.

Any mix is fine, as long as it's 32%. (Come to think of it, any color is fine, as long as it's black. )

Thanks to all for the explanations, they're a big help.