Wednesday, October 11, 2006

Follow up to change in mental status

This patient presented with change in MS. The CXR had shown some patchy markings but nothing specific. But the right hilar was full-looking so a CT was done:



Lung windows:


Thoughts?
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3 comments:

  1. AnonymousThu Oct 12, 11:57:00 AM

    Nocardia and other atypical agents would cause lung disease and CNS problems but the lp was negative
    There is a fairly large infiltrate with a mass. Lung Ca with paraneoplastic syndrome?

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  2. JenningsThu Oct 12, 12:54:00 PM

    He was bronched. Result is from Right middle lobe, transbronchial biopsy: Interstitial pneumonitis with focal eosinophils.

    Now what?

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  3. AnonymousFri Oct 13, 09:49:00 AM

    Interesting, but at this point a non-specific finding. Was there any peripheral eosinophilia? Was a BAL sent for a differential? Any evidence to suggest a vasculitis?

    With the mental status changes, if there are supporting data, you'd consider something like Churg-Strauss or even Wegeners here. Most other pulmonary eosinophilic syndromes (AEP, CEP) are not associated with CNS findings.

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