instruction: hello doctor I am a 67 year old female I have a significant past medical history of to and a lifetime history of bronchitis my arthritis is currently being treated with remicade last month while in a temporary job I developed severe altitude sickness sob fatigue and confusion followed by bronchitis stuffy nose and productive cough while there I needed to schedule a remicade infusion and the doctor there said she heard crackles in my lungs and sent me for an immediate chest ray high resolution it scan and a multitude of labs to my surprise I was diagnosed with ra not spa as my rheumatologist had diagnosed me before itself anyway the radiology results state honeycomb lung damage amongst other ominous findings at my follow up I was told I have ra ild I am now back to my place and have no symptoms to alert me of any lung problems I followed up with my pop last week and she did not hear crackles in my lungs my peak flow rate is 400 and my of sat is 100 at rest and 98 with fast walking I will send my radiology report and lab results my question is can the latent to lung scaring be misdiagnosed as ra ild or if I would appreciate your opinion
output: hello I can understand your concern according to your statement you have been suffering from chronic bronchitis with rheumatoid arthritis with recently diagnosed with ra related interstitial lung disease or idiopathic pulmonary fibrosis you had a history of pub and taking anti tubercular drugs you are concerned about your recent diagnosis based on hrct chest whether it is ra old if or latent to related complications for your past sufferings and now you feel a lot better your hrct of chest reveals interstitial fibrosis characterized by peripheral traction bronchiectasis irregular reticulation in all lobes microtubules with calcification in mid and lower lungs lower lobe predominant microcystic changes without significant ground glass opacifications hilar calcified lymph nodes consistent with chronic granulomatous disease and bronchial wall thickening bilaterally similar type of radiological findings can be found in post to fibrosis chronic obstructive pulmonary disease which includes two key components chronic bronchitis and emphysema ra old or if etc you may not tell your doctor about your previous history of latent to for that reason his diagnosis was ra old or if as you are suffering from ra so he was not wrong as your radiological reports suggest the above mentioned differential diagnosis again on high altitude your doctor found crackles as you are suffering from cold and it may be associated with infections that time and now it not heard as your infection was subsided