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Chest X-ray and spirometry

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I am curious what the line around the heart is on a chest x-ray. Had a spirometry done as well as an x-ray and everything came back normal?

Category: Pulmonologist

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Category: Allergy and Immunologist
Dr. Jacob George Pulinilkunnathil is online now

Expert:  Dr. Jacob George Pulinilkunnathil replied 4 Days.

dear patient,

Thank you for your consult at DoctorSpring.com.

Are you asthmatic? The air surrounding the heart and below is suggestive of collection of air in mediastinum - called pneumomediastinum. It is usually a benign condition, and the air gets absorbed by itself spontaneously. It can also be seen in young tall athletic males.

Can you post the second x ray also? In itself, although this condition is benign. It can recur, and may cause a crepitus like feeling on neck and below skin, and also at times can cause a pneumothorax - a condition that causes collapse of lungs.

I would be able to help you better if I have the 2nd x ray also.

Patient replied :

That is kind of what the Pulmonologist was trying to tell me but it was a little hard to understand him. My Primary thinks that I may have developed some slight asthma after I quit smoking. I quit smoking in June 2012 and started having shortness of breath feeling in November 2012. I am 5'10. Is this something that I should be worried about? Can I go and exercise normally? Would it have any affect on the heart like causing an abnormal fast or strong beat? As mentioned the bubble or pop feeling happens only in certain positions sitting and although it does not hurt I just wanted to double check. How else could air get around the heart or what is its potential cause?

Expert:  Dr. Jacob George Pulinilkunnathil replied 3 Days.

Hello again,

Ones lungs are something like a group of balloons suspended like a bunch of grapes from a height. so the tension inside a small balloon depends on how much it is stretched. Smoking further makes it weak. So at times, a small balloon might just pop off, causing air to leak along the mouth of the balloon, to where it is suspended. That is called pneumomediastinum! It is usually seen in asthmatics, and tall people, ( though 5 '10" is not a tall height, it is a normal height.)

Whether it will recur or not can be told only if i see a CT scan of your chest, which might show some weak areas. Most probably , you had only a bad balloon, which broke and it wont recur. but i will advice a ct chest to be on the safe side.

This time, the air leaked towardss the heart, slightly compressing it, so it caused only a forceful beat. but there can be some other complications, which I am not listing because they are rare, and I don't want you to be terrified.
So my opinion would be get a CT scan, see if there are more weak areas. If not, just forget it, and enjoy life.

if there is a weak area, then that will need OBSERVATION only and no immediate treatment. However i strongly advise to defer from smoking - active and passive.

Hope that helped. kindly feel free to clarify any doubts
Jacob George P

Patient replied :

Well thank you for the information. Since I have one free question left, how do the lungs look other than that? And since I've had the "bubble/pop" feeling for over a year, do you think eventually it will stop? Like a ruptured aveloi, does that heal itself? Thanks again.

Expert:  Dr. Jacob George Pulinilkunnathil replied 2 Days.

Dear patient, your chest x ray looked otherwise normal. The lungs seemed to be normal. However I have to confess that x ray is a poor way of assessment and assuring a patient about his lungs.

The test for the same will be ct scan. I do expect the pop sound to stop soon, probably in 2 weeks or so.

Regards, Dr. Jacob George.

Dr. Jacob George Pulinilkunnathil
Category: Allergy and Immunologist
Residency, Post Graduation: MD, Respiratory Medicine, J L N Medical College, Ajmer, Rajasthan (2012).
Medical School, Internship: MBBS, Government Medical College, Kottayam, 2001-07 
Indian Diploma in Critical Care Medicine (IDCCM) - Medical Trust Hospital, 2013-2014.
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