When comparing the two CT's side by side, her results proved to be more frustrating than we expected.
This CT was done without contrast (her original CT was done with contrast) so we did not get an image of the enlarged tracheal lymph node. So we do not know if the lymph node is the same size or if it has gotten bigger. Phoebe's lymph nodes enlarge due to hyperplasia (enlargement due to an increased rate of cell reproduction). Because they are enlarged from rapid cell growth and not just inflammed from fighting an infection, they do not reduce in size. They only get bigger. This lymph node will be something we need to find a way to monitor without needing multiple CT's, especially with it being on her trachea.
The CT did show the middle lobe atelectasis has improved. But they did find residual linear bandlike changes in the area. They also found multiple nodules through out both of Phoebe's lungs. The nodules range in size from 1 mm to 3-4 mm each. But what does all this mean?!
The linear bandlike changes are permanent scar tissue caused by the atelectasis. Irritants that we breathe in along with acute infections (like pneumonia) and chronic respiratory diseases (like asthma) all damage our lungs. This damage does not always completely disappear. Much like our skin when we get cut that leaves a permanent scar, showing where the damage was done.
The nodules, are a bit more complicated. Nodules in our lungs can be from irritants that we breathe in that get trapped inside the sacs of our lungs. In adults, the size of the nodules are what signals to a doctor if there is something to be concerned about, as well as determining what further testing is needed and how often to repeat imaging.
In children however....they do not have enough research to indicate any of that. They do not know what the size of the nodules mean in children, or how to safely follow or monitor the sizes of the nodules. The radiation risk to children from having frequently repeated CT's is high enough that the typical course to follow is to do nothing but manage the respiratory symptoms as they appear.