Discussions By Condition: I cannot get a diagnosis.

Question about Chest x-ray report, "volume loss function of splinting?"

Posted In: I cannot get a diagnosis. 6 Replies
  • Posted By: harry65
  • June 22, 2009
  • 10:28 PM

Hi, so here is my question. Should I just relax about this or should I make a bigger deal out of it and call the doc and really get in ASAP? You know how these things can sound all medically bad but be practically meaningless, like A.K.A "gas".

Anyhow, so I have some under the rib right sided pain, lightheadiness and possibly shortness of breath. Had a xray and the DOC posted the report for me online today and stated the following and will schedule a f/u visit:

"there was volume loss of the right hemithorax but it might be as a function of splinting".

What does that mean, why would I have a volume loss and is it bad? Soujnds better to have a loss then a gain (tumor) and what is splinting and how would that play into this? Should I be concerned and push for more immediate answers or should I relax and chill until the follow-up, is this a benign report?

Really apprecaite your professional feedback and thank you!

HK

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6 Replies:

  • Well, I need to obtain more about your medical history and the reason for the chest film, but let's talk about the radiologist's comments. Hemithorax simply means one side of the chest, in this instance the right side. Splinting is when a patient knowingly or unwittingly restricts respiratory effort due to discomfort at the site of inflammation or injury, most often a fractured rib from a fall or other blunt trauma, flail chest or alternatively, proximal inflammation from more primary disorder such as problems with your gall bladder or less commonly, the liver. Even diaphragmatic muscle strain can produce splinting. Realize that splinting commonly produces atelectasis, or sections of the lung where the aveoli are deflated or compressed. This would account for shortness of breath and to some degree, the lightheadedness due to more shallow and rapid respiration. Tell me more about the onset of your upper right quadrant pain. Incidentally, the radiologist's notation itself is merely an incidental finding at this point. Nothing to become alarmed about for the moment. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • I appreciate the reply- thank you. This started on and off maybe about two years ago. Same thing, pain under the ribs, mostly the directly under the bottom right rib cage. At that time a chest Xray showed that the pain was Pleuritic chest pain. I had also abdominal discomfort as well as muscle and joint pain but that started a little while before the above mentioned right sided chest pain and I assume unrelated. Labs were preformed, abnormal LFTs, Liver BX showed inflammation and according to the GI Doc suggestive of autoimmune hepatitis positive ANA, Elevated CPK (350-800 ranges).DX: autoimmune hepatitisDX: connective tissue disorder (responded to a steroid with intermittent flare-ups)DX: MIGRAINE w/ AUROADX: IBSI am a non smoker now for the past 5 years, 42 years of age, 205lbs and at this time my liver is fine and no organs are inflamed according to ultrasound. Regretfully blood work from last week not available yet (CBC).The pain I describe is intermittent, right sided, is sharpest directly under the bottom of my right rib, bottom of the rib is very sore to the touch. There has been no trauma, injury, break, etc. This is the exact pain that has occurred in the past; it had eventually resolved after about 4 - 6 months and now it's returned but more severe. It does seem as though it can intermittent radiate directly to right around to my back directly below my shoulder blade for very short periods. I would describe it as stabbing pain and it is moderate in intensity. Hopefully this isn't too much information and that it helps you help me know, should I worry or just lay low and take the result and wording as routine. It probabaly doesn't help that my PCP is out on vaca this week.
    harry65 3 Replies Flag this Response
  • P.S., I forgot to add and this may mean something.... The shortness of breath I describe doesn't occur during exercise. It mainly occurs at rest, especially while sitting or laying back. As for lightheadiness, it's a grab bag but it's can be sitting or it can be standing, walking, etc. I can feel as if I am right on the verge of passing out. If that helps at all. And thanks again.
    harry65 3 Replies Flag this Response
  • Okay, thank you for providing clarification. I suppose it's possible that you have autoimmune hepatitis, but realize that more than 70% of all cases are female and with the username Harry, I'll have to presume that you're male. Nearly all cases of AH are also assoicated with other autoimmune diseases present in the patient, such as diabetes type I, ulcerative colitis or Sjogren's syndrome. A positive ANA, in of itself, is not diagnostic. I would need to know the ratio in portions, indicated something like 1:640 as well as the pattern, ie homogeneous, speckled, centromere or nucleolar. IBS is less likely and the characterization of your pain and absence of other GI symptoms, unless they've not been revealed, would suggest otherwise. If you have other GI symptoms, please note them in detail as "abdominal discomfort" is not enough to glean the requisite impression. I would also ask here whether you've undergone an endoscopy to directly and thoroughly examine the duodenum, as well as the hepatopancreatic duct. Symptoms of URQ pain that are accompanied by referred pain under the right scapula are suggestive of a root stone at the base of the common bile duct, which is sometimes difficult to assess on imaging studies. The symptomatic pain associated with a root stone is typically a more dull pain at the anterior or frontal aspect of the URQ, that translates to a sharp, piercing pain at the right scapula which demonstrates a sort of pulsating exacerbation or increased intensity during the attack, most often occuring at late evening hours either while in bed or can awaken the patient from sleep. Walking or pacing, raising the right arm over the head, and other movements tend to decrease the intensity of the pain, sometimes relieved by belching as well. At the point the subscapular pain is most intense, the URQ pain is lessened by a good margin, barely comparable. It is uncommon for the liver itself to produce pain unless significantly inflammed and the presence of liver problems are likely coincidental to the pain. It's also a possibility that the duodenum itself may be responsible. If they imaged the liver, I would presume that they evaluated your gall bladder and duodenum as well, but it would be wise to ensure that this was done. If not, then with the history demonstrated, a direct endoscopy would be suggested here to rule out any cause for the pain. Hope this helps. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
  • Thanks very much! That provides some good clarification. On that ANA there were many repeats and they "generally" fell into the 1:360 range and came back as either speckled (usually) or in a few cases nucleolar but it isn't clear to me the significance. And to be honest I really hadn't been much of a follow up guy once I started feeling a little better. Personally I think it may have been a just a short term thing and it seems to have passed.Anyhow... back to the my question.. Other than splinting, what might else be a possible root cause for this volume loss of the right hemithorax? Thanks again, Harry.
    harry65 3 Replies Flag this Response
  • Well, it's fairly safe at this point to say that the volume loss is not due to a space-occupying mass of some type and the fact that you were a former smoker is something that I'm sure has you concerned. The presence of a mass on imaging would have been remarkable, being noted and reported by the radiologist. It's an extreme disadvantage here to try and speculate about the cause for the volume loss in the absence of being able to directly examine the images and medical history. My suggestion here is to try and relax while awaiting the follow-up. Once you've visited your doctor and have the full results, I'd be glad to discuss any findings that you wish to post. Best regards, J Cottle, MD
    JCottleMD 580 Replies Flag this Response
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