Chest x-ray & the CT follow ups:

Crazy paving pattern:
(pulmonary hemorrhage)

It consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. This finding has a variety of causes, including infectious, neoplastic, idiopathic, inhalational, and sanguineous disorders. Specific disorders that can cause the crazy-paving pattern include Pneumocystis carinii pneumonia, mucinous bronchioloalveolar carcinoma, pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonia, organizing pneumonia, exogenous lipoid pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage syndromes.




Links:
http://radiographics.rsna.org/content/23/6/1509.full





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Round Atelectasis

Round atelectasis (also known as folded lung or Blesovsky syndrome) is an unusual type of atelectasis where there is infolding of a redundant pleura . The way the lung collapses can at times give a false mass like appearance.

It can be seen association with

• asbestos lung exposure ³ : most commonly
• therapeutic pneumothorax in the treatment of tuberculosis ¹
• congestive heart failure ²
• pulmonary infarction ²

HRCT : Chest

• almost always seen adjacent to a pleural surface
• comet tail sign ² : produced by the pulling of bronchovascular bundles giving the shape of a comet tail

Links:
http://radiopaedia.org/articles/round-atelectasis


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Sarcoidosis

• Lymphadenopathy, (80%) most common finding – bilateral hilar/paratracheal
  Usually not visible at 2 years; may persist for many years
  Nodes may calcify, sometimes eggshell calcification
• Lung disease, (<50%), often manifest with nodal regression
• Pattern and Distribution:
  • Reticulonodular opacities (90%)
  • Large airspace nodules with air bronchograms
  • Fibrosis mid and upper lung zones
  • Upper lobe cyst formation with aspergilloma

Stage 0 – clear chest radiograph (5 – 15%, at presentation)

Stage 1 – lymphadenopathy (45 – 65%); 60% resolve completely

Stage 2 – lymphadenopathy and lung opacities (30 – 40%)

Stage 3 – Lung opacities (10 – 15%)

Stage 4 – fibrosis with or without lymphadenopathy (5 – 25%)

• Atypical appearance
  • Atypical lymphadenopathy - unilateral hilar, posterior mediastinal
  • Airway compression
  • Unilateral lung disease
  • Cavitary lung lesions
  • Pleural effusion

CT may show lymphadenopathy at left paratracheal, AP window, anterior mediastinum, retroperitonealHRCT, may be abnormal with normal CXR.

Predominantly involves the mid and upper lung zones

Pattern: 1 – 5 mm centrilobular nodules along brochovascular structures, septa, and periphery of lobuleOften extends in a swath from the hilum to lung periphery Ground glass opacities
Progressive massive fibrosis, distortion, honeycombing, cysts, bullae, traction bronchiectasis
Mycetomas in cavities and cystsLarge and small airway stenoses

Differential Diagnosis:
Granulomatous diseases : TB, fungal infection, berylliosis, extrinsic allergic alveolitisDiseases with granuloma-like reactions: lymphoma, carcinoma, metastases
Chronic eosinophilic pneumonia, BOOP Pathological Features Common systemic disease. Widespread noncaseating granulomas, that resolve or cause fibrosis.

Etiology: unknown

Onset – usually age 20 to 40

Asymptomatic, or fatigue, malaise, weight loss, fever, respiratory symptoms, erythema nodosum, uveitis, skin lesions, arthropathy, bone lesions

In < 2% TB precedes sarcoidosis or develops later.
80% of cases resolve completely; in 20% fibrosis develops that may destroy and distort the lung
Anemia, leukopenia, elevated sedimentation rate, hypercalcemia, nephrolitiasis.
Cutaneous anergy.

Usually not treated; steroids in severe cases
Recurrence in transplanted lung has been reported
Prognosis worse in blacks
Mortality – 2 – 7%; death from respiratory failure, cor pulmonale, hemorrhage

LINKS:
http://www.chestx-ray.com/HRCT/HRCTpicker/index.htm

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Tracheal distention following intubation

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CXR performed after VATS biopsy


CT scan showing multiple peripheral contrast enhancing leasions



- The chest x-ray of this patient could resemble a pneumonia or even edema, but the round multiple leasions seen on the CT suggest pulmonary mets.
- The patients lung leasions were incidentally found as part of a neurosurgical pre op. check up. - - The patient had a 6 month long history of coughing and fever.
- The histology results has not returned yet...


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Fibrosis pulmonum mai grad.
Pneumonia l.d.


The CT suggested active TBC, with caverna and a preexisting silicosis.

Calcified hilar lymphnodes

Microbiology from lung biopsy specimen: negative
Labs: WBC: 21000 , Neutrophyl: 91 (37-80), Lymphocyte: 5 (10-50), CRP 19