Are subpleural fibrotic densities on the HRCT concerning?

Question

Hi doctor,

My husband is 39-years-old, and he went for high resolution computed tomography (HRCT) as a prerequisite for eye surgery to check for COVID. Though it was negative for COVID had a comment like small subpleural fibrotic densities seen are of post-infection etiology. Is this progressive fibrosis or some residual scarring? Does it need an immediate work-up? I have attached the reports for your reference.

Kindly give your opinion.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

According to the HRCT (high-resolution computed tomography) of your husband's chest, the report has revealed that small subpleural fibrotic densities in the right middle lobe and Antero basal segment of the right lower lobe (attachments removed to protect the patient's identity) are post-infectious etiology. Subpleural fibrotic densities mean thickening or scarring of the tissue in the subpleural region.

The thin and lacy walls of air sacs in the lungs lead to thick, stiff, and scarred in such cases. This condition is also called fibrotic. Some known causes and unknown or idiopathic reasons may cause such type of fibrotic changes in radiological films. Idiopathic etiologies, post-infectious etiology, like any previous respiratory infections, exposure to occupational or environmental toxins like asbestos, coal, dust, or silica, autoimmune diseases like SLE (systemic lupus erythematosus), rheumatoid arthritis, scleroderma, or Sjogren's syndrome, some medications, genetics, and many more causes it.

Symptoms of fibrotic changes may vary from person to person. Some people may stay in stable condition for years, while others may suffer from rapidly worsening symptoms. Common symptoms are chronic dry cough, shortness of breath, exertional dyspnea, and easily becoming fatigued, etc. CT (computed tomography) guided FNAC (fine needle aspiration cytology), or biopsy from the fibrotic lung tissue, may confirm the underlying causes.

So, your husband may need to undergo CT-guided FNAC or biopsy to find out the exact etiology of the fibrotic changes and then treat them accordingly. As your husband's HRCT of the chest has suggested that the fibrotic changes may result from post-infectious etiology, and at present, he is free from any respiratory complications or symptoms, so keep patience and observe. Without symptoms, usually, no medical treatment is needed.

Again, any person with a history of pneumonia for six months due to the COVID-19 virus, bacterial, or any other reasons may cause such type of fibrotic changes in the lungs.

I hope this was helpful.

Thank you.