A 64 year old woman had a screening CXR because of previous smoking history leading to a CT showing upper lobe central bronchovascular densities with a bit of ground glass.
She is entirely asymptomatic and has no medical probs. She is obese, but exercises 3 x a week.
Question: would you work this up or discharge her from the clinic with f/u if symptoms develop?
BTW her spiro shows obstructive ratio with FEV1 85% predicted.
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The fact that she is asymptomatic is encouraging though I might follow her up at least once before D/C'ing her: this could be non-specific benign inflammation but then she should have been symptomatic. With the bronchovascular distribution she may have sarcoid and f/up would be helpful and since she is a former smoker BAC could look like GGO...
Of course it will be none of these things and she will be fine but I guess I would err on the follow up side for a former smoker with an abnormal CT scan.
Well, let's say you repeat a CT and you have the same markings but she is asymptomatic. You STILL will not proceed with w/u or interven right? And if it's negative you don't do anything either. Thus, why even repeat the CT (unless she becomes symptomatic)?
Because of the thrid option: if it gets bigger or different I WOULD do at least a bronch and since the current abnormality is asymptomatic, chances are if it grows it may still be asymptomatic and you won't know until things have grown and spread...
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