Monday, February 20, 2006

Shortness of breath over a 2 month period

This 50 y/o AA woman presented with shortness of breath. Without further history, what would be your (not necessarily complete) DDX based on the CT. Also note the mediastinal nodes (arrows).

2 comments - CLICK HERE to read & add your own!:

Arenberg said...

The upper lobes show small, thin walled cystic changes, but this doesn't look like emphysema. ITs not classical IPF (UIP) either), so I'd go with a more rare ILD like langerhan's cell histiocytosis (EG), or LAM since I can't see stellate nodules clearly.

The bases look very different. She has some of what looks like dense consolidation, and some associated bronchiectasis. I have a hard time reconciling the upper & lower lobe findings easily.

The large lymph nodes could be saroid, reactive (to the airspace disease) or fibrotic from olf fingal disease. One of the lymph nodes in the high paratrachel ragion looks like it is enhancing with contrast.

I'll stick my neck out some and say she has EG, plus something else, probably unrelated, going on in the bases like an active infection, or a drug reaction (amiodarone?).

Jennings said...

Your thoughts are great. This CT is on a patient that is scheduled to see me, but I haven't seen her yet. I just wanted to see what DDx's others would have based on that CT. When I see her I will post a follow-up and link back to this post.
Anyone else want to weigh in?