Forty-year-old woman presents to ER with dyspnea.

Contributed from the case records of the  Indiana University Department of Radiology

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Which choice is most appropriate?

Pulmonary embolism.Intracardiac mass.Pericardial thickening.Anomalous pulmonary venous return.No significant abnormality.

Forty-year-old woman presents to ER with dyspnea.

Here are some lung-window images from the same scan. Click to enlarge.


The patient is NOT a smoker

What is in your differential diagnosis? What is your favored diagnosis? (Discussed further on next page).

Forty-year-old woman presents to ER with dyspnea.

Differential diagnosis for cystic lung disease:

• Langerhans cell granulomatosis (EG)
• Lymphangioleiomyomatosis (LAM)
• Emphysema (centrilobular)
• Idiopathic pulmonary fibrosis
• Pneumocystis

Forty-year-old woman presents to ER with dyspnea.

Key points: 

• LAM is hamartomatous proliferation of smooth muscle around lymphatics and blood vessels that progress to replace the normal lung with cysts. Usually found in women of childbearing age.
• Lymphocytic interstitial pneumonia is from chronic antigenic stimulus eliciting lymphoproliferative response. My be idiopathic or secondary to autoimmune etiology, viral infection (especially HIV), and Castleman disease.
• Langerhans cell granulomatosis is likely secondary to allergic reaction to smoke. It may regress, resolve completely, become stable, or progress to advanced cystic disease.
• Desquamative interstitial pneumonia is associated with smoking 90% of the time. Predominant in the lower lungs. Small well-defined cysts. Best clue is smoker with ground glass opacities.

References:

1. https://my.statdx.com/get.summary?dxId=desquamative_interstitial_pneumonia.
2. https://my.statdx.com/get.summary?dxId=lymphangiomyomatosis_dx.
3. https://my.statdx.com/get.summary?dxId=lymphocytic_interstitial_pneumonitis_dx.
4. https://my.statdx.com/get.summary?dxId=langerhans_cell_granulomatosis__pulmonary.

Forty-year-old woman presents to ER with dyspnea.

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