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Weekly Chest CasesArchive of Old Cases

Case No : 904 Date 2015-02-23

  • Courtesy of Jeong Min Ko, Hyun Jin Park / St. Vincent’s hospital, The Catholic University of Korea
  • Age/Sex 48 / M
  • Chief ComplaintChronic cough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Langerhans cell histiocytosis
Radiologic Findings
Chest radiograph shows ill-defined small nodular opacities in both lungs with upper lung zone predominance. Chest CT scans demonstrate numerous thick- and thin-walled small lung cysts and micronodules in both lungs with upper lung predominance. He underwent VATS wedge resection of right upper lobe and finally diagnosed as pulmonary Langerhans cell histiocytosis. His medical record revealed that he was a 30 pack-year current smoker.
Brief Review
Langerhans cell histiocytosis is a rare disease of unknown etiology, however, 90% or more of the patients are cigarette smokers. In the early stages, HRCT findings include centrilobular opacities and small nodules with bilateral and symmetric distributions. Nodules have irregular borders and are predominantly distributed in the upper, middle lung zones with sparing of lung bases near costophrenic angles. Early stage of the disease is characterized by the abundance of nodules and cavitated nodules, whereas cysts are few and do not tend to be confluent. The differential diagnosis of early stage of this disease includes pulmonary papillomatosis and cavitary metastasis.
Advanced disease is characterized by a small number of nodules, whereas cysts have increased in number and size and are confluent. The following sequence of abnormalities seen with CT corresponds to the evolution of the disease; nodules, cavitated nodules, thick-walled cysts, cysts, and confluent cysts, rupture or collapse of cysts with or without pneumothorax. Although many cysts appear round, they can also have bizarre shapes, being bilobed, clover-leaf shaped, or branching in appearance. The cystic manifestation can mimic that of bullous emphysema or lymphangioleiomyomatosis.
Please refer to
Case 32, Case 226, Case 367, Case 422, Case 654, Case 680, Case 849,
References
Keywords
Lung, Interstitial lung disease, smoking related ILD,

No. of Applicants : 91

▶ Correct Answer : 73/91,  80.2%
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - All India Institute of Medical Sciences , India Jitesh Ahuja
  • - McGill University Health Center , Canada Alexandre Semionov
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - �stanbul , Turkey Ayhan Yilmaz
  • - CHRU Lille , France Julien Pagniez
  • - CHRU Lille , France Jeremy Hanckowiak
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Kosin University Gospel Hospital , Korea (South) Hee Kang
  • - university of montreal , Canada Andrei Gorgos I
  • - Niigata University , Japan Atsushi Uehara
  • - alzahra , Iran johary s
  • - CHRU Lille , France Paul Lebert
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - SNUH , Korea (South) Eui Jin Hwang
  • - CNUH , Korea (South) Noh Hoon
  • - GHICL , France manuel toledano
  • - Tong young Red cross hospital , Korea (South)
  • - SALMAN IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Kyung Hee University Hostpital at Gangdong , Korea (South) Jun-Hyung Lee
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Seoul National University Hospital , Korea (South) Sunkyung Jeon
  • - 異⑸ , Korea (South) Yunhee Jang
  • - Hi hospital , Korea (South) 源€吏€
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - University of the Ryukyus , Japan Nanae Tsuchiya
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - CNUH , Korea (South) LEE JONG EUN
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
  • - , Korea (South) Chan Park
  • - i.r.c.c.s.istituto scientifico romagnolo per lo studio e cura dei tumori , Italy Alice Rossi
  • - Severance hospital , Korea (South) SeungHyun Park
  • - 媛€ , Korea (South) Jo Yeseul
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - AP-HP , France Amir JAFF
  • - VHS medical center , Korea (South) Keuntak Roh
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - CHU Poitiers , France CHAN paul
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - Dept.of radiology, SCHBC , Korea (South) Soyeoun Lim
  • - Asan Medical Center , Korea (South) Wonjin Choi
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - NASA SCANS , India RAKESH BHATIA
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Fukuyama City Hospital , Japan Mayu Uka
  • - santosh hospital , India Pravin Mahadevappa
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - CLCC Rennes , France nicolas gautier
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - Ibaraki-gazou-shindan , Japan Shoichi Katoh
  • - SNUH , Korea (South) Roh-Eul Yoo
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Medicheck health care , Korea (South) Chae Lim
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - All India Institute of medical sciences , India Justin Moses
▶ Correct Answer as Differential Diagnosis : 10/91,  11.0%
  • - Seoul National University Hospital , Korea (South) Hyoung-In Choi
  • - University of British Columbia , Canada Amr Ajlan
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Kyoto University , Japan Akihiko Sakata
  • - Haeundae Paik Hospital , Korea (South)
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Chonnam national university hospital , Korea (South) INSOO JANG
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - chp st martin , France Mariotte benoit
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