Gray-White Lung X-Ray: Causes of Breathing Difficulties and Edema

The X-ray of the lungs shows a grayish-white appearance?

Hello: My grandfather has fainted due to difficulty breathing and is currently in the intensive care unit.
He was discharged last week after the TB bacterial load reached a non-infectious level, but why did he suddenly experience difficulty breathing and faint? Could it be that the tuberculosis bacteria have caused calcification in the lungs? (However, at the time of discharge, we were only advised to wear a mask, which suggests that the impact on the lungs was not severe enough to cause breathing difficulties.
If lung calcification were to affect respiratory function, shouldn't the physician have recommended the use of oxygen?) Currently, my grandfather's temperature, pulse, and blood pressure are all within normal ranges, with a GCS of 3, peripheral edema, and his chest X-ray shows a grayish-white appearance (he is on a ventilator).
I would like to understand why there is peripheral edema and what the grayish-white appearance on the chest X-ray indicates.

Xiao Tu, 10~19 year old female. Ask Date: 2004/11/16

Dr. Zhao Chongliang reply Internal Medicine

Hello! Based on your description, your grandfather's chest X-ray appears to show signs of either cardiogenic pulmonary edema or non-cardiogenic pulmonary edema, such as renal-related pulmonary edema or acute respiratory distress syndrome (ARDS).
Cardiogenic or renal-related pulmonary edema is more likely to cause peripheral edema.
Given your grandfather's situation, the treatment for tuberculosis has shown progress and should not lead to ARDS; such a condition would typically indicate severe tuberculosis or other specific sites of infection, such as pancreatic tuberculosis.
If your grandfather has a history of heart disease, particularly heart failure, or kidney disease, such as renal failure, this could lead to cardiogenic or renal-related pulmonary edema.
It is worth noting that tuberculosis medications can potentially harm the liver or kidneys, especially in older patients.
Among the commonly used tuberculosis medications, Ethambutol and Streptomycin are known to be nephrotoxic.
It would be important to know your grandfather's liver and kidney function values before and during treatment to determine if the renal failure is drug-induced.
Currently, with your grandfather's Glasgow Coma Scale (GCS) score at 3, the outlook is quite poor.
If the renal failure is indeed drug-induced, stopping the medication immediately might still offer a chance for recovery; otherwise, the situation may be irreversible.
Calcification does not cause these critical conditions.
After effective treatment for pulmonary tuberculosis, the infectiousness decreases significantly, typically becoming non-infectious within 1 to 4 weeks.
Therefore, patients are usually kept in isolation for two weeks, and after discharge, wearing a mask for an additional two weeks is recommended to confirm non-infectious status.
Unless using an N100 mask, it is unlikely to cause respiratory distress or pulmonary edema.

Reply Date: 2004/11/16

More Info

I'm sorry to hear about your grandfather's condition. It sounds like a very challenging situation for your family. Let's break down the information regarding his breathing difficulties, the X-ray findings, and the potential causes of his symptoms.

Understanding the X-ray Findings
When an X-ray shows a "gray-white" appearance in the lungs, it typically indicates the presence of fluid, inflammation, or consolidation in the lung tissue. This can be due to various conditions, including pneumonia, pulmonary edema, or even the aftermath of a previous infection such as tuberculosis (TB). In your grandfather's case, since he was recently treated for TB, it's possible that the lung tissue has been affected by the infection, leading to changes in the lung architecture.

Causes of Breathing Difficulties
Breathing difficulties can arise from several factors, especially in the context of a recent TB infection:
1. Pulmonary Edema: This condition occurs when fluid accumulates in the air sacs of the lungs, making it difficult for oxygen to enter the bloodstream. It can be caused by heart failure, kidney problems, or severe infections. The presence of edema can lead to a gray-white appearance on an X-ray.

2. Infection or Inflammation: Even after TB is no longer infectious, the lungs may still be inflamed or damaged. This can lead to scarring or fibrosis, which can impair lung function and cause breathing difficulties.

3. Calcium Deposits: If TB has caused calcification in the lungs, it may not directly cause breathing difficulties unless it has led to significant structural changes or scarring. However, calcified lesions can sometimes indicate a past infection that has resolved but left behind changes in lung function.

4. Acute Respiratory Distress: If your grandfather is on a ventilator, it suggests that he is experiencing severe respiratory distress, which could be due to any of the above factors or a combination thereof.

Understanding Edema
The presence of edema in the limbs (four limbs swelling) can be indicative of several underlying issues:
1. Fluid Retention: This can occur due to heart failure, where the heart is unable to pump effectively, leading to fluid buildup in the body. It can also be a result of kidney dysfunction, where the kidneys are unable to excrete excess fluid.

2. Hypoalbuminemia: Low levels of albumin (a protein in the blood) can lead to fluid leaking from blood vessels into surrounding tissues, causing swelling.

3. Inflammatory Response: Infections can trigger an inflammatory response, leading to increased permeability of blood vessels and subsequent fluid accumulation in tissues.

Conclusion
Given your grandfather's recent TB treatment and current symptoms, it is crucial for the medical team to monitor his lung function closely. The gray-white appearance on the X-ray, along with his breathing difficulties and edema, suggests that he may be experiencing significant pulmonary complications. It's essential that he receives appropriate respiratory support, which may include oxygen therapy or mechanical ventilation, depending on his condition.

While it is understandable to be concerned about the implications of these findings, the medical team will be able to provide the best guidance based on ongoing assessments. They will consider all factors, including his vital signs, lab results, and imaging studies, to determine the most appropriate course of action.

If you have further questions or concerns, I encourage you to discuss them with the healthcare providers directly involved in your grandfather's care, as they can provide the most accurate and personalized information.

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