How to manage pneumothorax and mediastinal emphysema?

Question

Hi doctor,

I am seeking a specialist's opinion. My wife has been diagnosed with pulmonary fibrosis. She has a small rim of pneumothoraces bilaterally, along with subcutaneous emphysema and mediastinal emphysema. I am attaching her reports. Kindly suggest a treatment plan to manage her condition.

Thank you.

Answer 1

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 the 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. Also, your wife seems to have idiopathic pulmonary fibrosis.

This condition is treated by taking steroids according to weight. If the oxygen saturation is not above 92 percent on room air, then oxygen supplementation is given either by cylinder, concentrator, or NIV (non-invasive ventilation). She can take the tablet Medrol (Methylprednisolone) as per the weight. In severe cases, oxygen supplementation is needed.

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 they should be treated simultaneously.

I hope this has helped you. Please feel free to reach out to me again in case of further queries.

Thank you.

Answer 2

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 (nutritional supplement).

Due to disease progression, the effects of the medicine had decreased, and her symptoms got worse. In this condition, it is good to consult a pulmonologist, and she can take the tablet Pirfenex 150 mg (Pirfenidone). It helps a lot.

It is necessary to monitor her liver function tests after taking the 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.

I hope this has helped you. Please feel free to reach out to me again in case of further queries.

Thank you.