Discussion of interesting or befuddling cases related to pulmonary and critical care medicine.
Thursday, February 23, 2006
What's the diagnosis
No history. 18 year old woman. What's your differential? How about some others leaving a comment (you can do so anonymously - you dont have to log in, just click comments below this post):
So, he has multiple non-calcified pulmonary nodules, many with cavitation. I don't see underlying parenchymal disease or large adenopathy. He seems a bit young for malignancy but testicular cancer can present in this age group with multiple nodules. However, cavitation of metastatic lesions occurs in less than 5 percent of cases. Wegener's can also present with multiple nodules and those are more likely to cavitate though he seems quite young. I would favor an infectious etiology here. Septic emboli (perhaps IVDA) could look like these nodules, and so could histo. Cocci could also look like that but I think Jeff would have given us a little travel clue (same with Paragonimus...).
Good pick up. She is IVDA and has MRSA tricuspid endocarditis with septic emboli. She has a $200/day heroin habit and prostitutes for the cash. Surprisingly, she is HIV negative.
So, he has multiple non-calcified pulmonary nodules, many with cavitation. I don't see underlying parenchymal disease or large adenopathy.
ReplyDeleteHe seems a bit young for malignancy but testicular cancer can present in this age group with multiple nodules. However, cavitation of metastatic lesions occurs in less than 5 percent of cases.
Wegener's can also present with multiple nodules and those are more likely to cavitate though he seems quite young.
I would favor an infectious etiology here. Septic emboli (perhaps IVDA) could look like these nodules, and so could histo. Cocci could also look like that but I think Jeff would have given us a little travel clue (same with Paragonimus...).
it's a WOman
ReplyDeleteGood pick up. She is IVDA and has MRSA tricuspid endocarditis with septic emboli. She has a $200/day heroin habit and prostitutes for the cash. Surprisingly, she is HIV negative.
ReplyDeleteAnother thing that could do this is a peripharyngeal fascial 'space' infection.
ReplyDeleteIf she was an "upstanding" member of the community, I would ask about upper resp symptoms (especially sore throat).
Cool CT