Doc: Should ‘benign mucus plugging’ prompt doc visit?
Dear Dr. Roach: I had a CT scan in July as part of my follow-up care for grade 1 chondrosarcoma. My scans were good, showing no cancer issues; however, one item that was noted said, “scattered areas of benign mucus plugging.” This was the first time that particular issue had been noted. My orthopedic oncologist did not mention this at all, and the only reason that I have taken note of it is because another member of the chondrosarcoma support group I belong to mentioned that she had them noted on her scan, and asked if other people had seen it, as well.
I contacted my primary care physician to ask what it means, and she said that the note saying they were benign indicates that there isn’t anything necessarily to worry about, but said she could refer me to a pulmonologist if I would like a referral. I really don’t want to have any additional specialist visits if there is no need, but I still don’t understand what it means. I tried to look it up online, but it was mostly referring to people with asthma, cystic fibrosis and COPD. I do not have any of those conditions. I quit smoking in 1987. My question really is if I should ask for a referral to a pulmonologist, or if this is something that can be ignored. I am a retired 65-year-old woman in good health, and I exercise on a recumbent bike and treadmill almost every day for at least an hour. I have not noticed any breathing difficulties while I am exercising.
Dear T.M.H.: The lining of the lung is protected by cells producing mucus, and cilia (small, hairlike projections on the cells lining the airways) continuously clear the mucus. Occasionally the mucus gets too thick, and literally can plug a small airway. This can be removed with a forceful cough.
Mucus plugs certainly can be found in people with no lung problems. I think they probably have nothing to do with the chondrosarcoma, a malignant tumor of cartilage (usually on a bone), which can spread to the lung (the CT scan is to look for tumor). It’s possible you have some distant residual damage from smoking years ago or that you have asthma that is so mild you haven’t noticed it. However, since you are able to exercise without problems (congratulations on keeping so active), I agree with your primary care doctor that further evaluation probably is unnecessary.
Dear Dr. Roach: I’m a 63-year-old female who’s having a real hard time deciphering if the redness and intense heat on my face (normally on my right side) is rosacea or menopause. There is some sweating also, but not a lot. I’m on hormones for menopause, but if it’s actually rosacea, then I could come off them. I really don’t have to be doing anything (nowadays) when it just randomly comes on. How do I tell which it is?
Dear D.H.: Rosacea is a chronic skin disorder that is most conspicuous on the face. It can get worse periodically, which might seem similar to menopausal hot flashes (and of course it’s possible to have both). However, rosacea flares usually are triggered by something identifiable: drinking hot liquids, exercise, strong feelings. Hot flashes usually come out of nowhere, and the skin is normal when not flushed.
The skin findings of rosacea are characteristic, present all the time, and most generalists and any dermatologist should be able to make the diagnosis by exam; occasionally, a biopsy is needed. There are several types of rosacea, each with characteristic findings: learn more at rosacea.org.
Email questions to ToYourGoodHealth@med.cornell.edu.