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Pulmonary injuries

Question
Hello,
Can you please explain me what types of lesions can be seen in a young asymptomatic patient and what treatments can be put in place.
Our CF Centre talks about the possibility of perfectly silent and asymptomatic lesions.
We question the interest of exposing a child to the radios of an XRay every year in the absence of clinical signs (infections, cough ...). Especially if it is just to find lesions for which there are no treatments.
Thank you very much for your help.
Cordially
Answer
Hello,

Radiographic signs of broncho-pulmonary disease are very different in their anatomical nature and intensity. Schematically, these may be signs that are related to bronchial dilatation (bronchiectasis) or to ventilation disturbances causing distension of a pulmonary territory (reversible as in an asthma attack or persistent as in emphysema) or, on the contrary, its retraction (atelectasis).

The radiological signs of lung lesions linked to cystic fibrosis or their evolution may indeed be perfectly silent. It is therefore justified to carry out a systematic thoracic radio, at least:

- during the diagnosis, even in the absence of clinical respiratory symptoms, since the presence of radiological signs may contribute to the diagnosis and / or the decision to treat. It's the case :
o in neonates detected by systematic neonatal screening and whose respiratory symptoms may be discrete or even absent: this first radio, even normal or quasi-normal, will serve as a comparison to judge subsequent evolutions;
o in people with an atypical form of cystic fibrosis which can manifest itself by sterility secondary to bilateral atresia of the spermatic vas deferens. The discovery of radiographic signs then reinforces the diagnostic suspicion and justifies the use of a sweat test and a genetic test for confirmation.

- in an annual follow-up report, even if the clinical signs do not indicate a change in the respiratory state: a modification of the radiological signs may reflect a lung infection evolving in silence but requiring a therapeutic decision sometimes after other radiological examinations such as CT scans. The absence of radiological evolution will make it possible to update the radio of comparison in order to judge the later evolution.

It is important to prevent the risks of excessive irradiation due to radiological examinations not based on good medical practice. It is advisable to be especially vigilant in case of chronic illness requiring repeated examinations. But the prevention of the risk related to X-rays is a question of moderation because one must also take into account the risk of letting evolution of a silent complication and of intervening too late with irreversible lesions. It should be noted that on earth all human beings are exposed to natural irradiation from the cosmic rays, the rocks composing the earth's crust as well as human activity. The irradiation associated with a thoracic radio is equivalent to the natural irradiation received during 2 ½ days.

Hoping to have answered your question.
Best regards,

Gilles RAULT, MD
CF Centre Roscoff, Foundation ildys

24.02.2017