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Weekly Chest CasesArchive of Old Cases

Case No : 654 Date 2010-05-09

  • Courtesy of Soo-Youn Ham, Yu Whan Oh / Dept. of Radiology, Korea University Medical Center, Anam Hospital
  • Age/Sex 44 / F
  • Chief ComplaintSmoker, PHx: Lt MRM due to breast cancer
  • Figure 1

Diagnosis With Brief Discussion

Diagnosis
Langerhans cell histiocytosis
Radiologic Findings
Brief Review
PLCH is a part of spectrum of disease now collectively known as Langerhans' cell histiocytosis. The classification has been simplified and is based on the presence of single or multiorgan involvement. In the majority of patients PLCH is isolated to the lungs with only 5% to 15% demonstrating multiorgan involvement including bone lesions, skin lesions, and diabetes insipidus. Patients most commonly present with dypnea and cough, although up to 25% are asymptomatic at the time of disease discovery. PLCH primarily affects individuals in the 3rd to 5th decade of life, however, the relative frequency of males and females. The pathogenesis remains unknown, however, 90% or more of PLCH patients are cigarette smokers. The early imaging features are small nodules ranging from 1 to 10mm, bilateral, symmetric distributions. Nodules have irregular borders, predominenty distributed in the upper, middle lung zones with sparing of lung bases near costophrenic angle. As the diseases progresses, reticulonodular abnormalities are noted. Further progression results in a predominance of cystic changes. As cysts become more numerous, nodules tend to occur less frequently. The cystic manifestation can mimic that of bullous emphysema or lymphangioleiomyomatosis, with multifocal contiguous cysts measuring up to 2-3 cm in diameter. The end stage of PLCH is characterized by coarse reticular areas of opacity that tend to occur in the upper, middle lung zones that may progress to honeycomb lung. Lung volumes are normal or increased in most patients with PLCH. Pneumothorax is a recognized complication.
References
1. Abbott GF, Rosado-de-Christenson ML, Franks TJ, Frazier AA, Galvin JR. From the archives of the AFIP Pulmonary langerhans cell histiocytosis. Radiographics. 2004 May-Jun;24(3):821-41
2. Galvin, Jeffrey R, Franks, Teri J. Smoking related lung diseases. J Thorac Imag. 2009; 24(4):274-284
Keywords
Lung, Interstitial lung disease, LCH, smoking related ILD,

No. of Applicants : 113

▶ Correct Answer : 39/113,  34.5%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Osaka University , Japan Osamu Honda
  • - Hospital M�e de Deus , Brazil Thiago Bento da Silva
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - hospital de clinicas de porto alegre , Brazil ana zanardo
  • - Department of Diagnostic Radiology, Chonbuk National University Hospital , Korea (South) Eun Jung Choi
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Dong-A university hospital , Korea (South) Sang-yun LEE
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - radiologist, aditya imaging centre , India vivek patel
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Saga University , Japan Ryoko Egashira
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - 세브란스 , Korea (South) 이경종
  • - IRCCS S.Luca Hosp. , Italy filippo casolo
  • - CHU NANCY , France, Metropolitan GREGORY LESANNE
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - royal melbourne hospital , Australia Kimchi Kings
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - SoonChunHyang univ. hospital , Korea (South) Kim Jae Hyun
  • - Seoul National University Hospital , Korea (South) Hyungjin Kim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Bundang CHA hospital , Korea (South) Sojung Kim
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - medical , India anup kumar
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Asan Medial center , Korea (South) Chae Lim
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Chonnam National University Hospital , Korea (South) Daun Lee
▶ Correct Answer as Differential Diagnosis : 13/113,  11.5%
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - SMG-SNU boramae medical center , Korea (South) Kwang Nam Jin
  • - Samsung Medical Center , Korea (South) Eun Kim
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Nonsan Hospital , Korea (South) Eun-Tae Park
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun JunYeh
  • - Kangnam severance hospital , Korea (South) Song Jae Min
  • - sunder lal jain hospital , India sanjeev vachher
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - All India Institute of medical sciences , India Justin Moses
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - IRSA , France jean-luc BIGOT
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