Weekly Chest CasesArchive of Old Cases

Case No : 682 Date 2010-11-22

  • Courtesy of Yoon Kyung Kim, Hwan-Seok Yong, Eun-Young Kang / Korea University Guro Hospital
  • Age/Sex 28 / F
  • Chief ComplaintAggravation of dyspnea after delivery
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Lymphangiogleiomyomatosis
Radiologic Findings
Posteroanterior chest radiograph shows subtle reticular densities in both lungs. CT scans show innumerable, thin-walled cysts in both lung fields without zonal predominance.
Brief Review
.Women of reproductive age
.Symptom
- recurrent spontaenous pneumothorax, slowly progressive dyspnea, hemoptysis, chylothorax, chylous ascites
.Pathologic findings
- proliferation of immature appearing smooth muscle cells (LAM cells) in the lungs and axial lymphatics in the thorax and abdomen
- formation of thin-walled pulmonary cysts
.Extrathoracic involvement
- kidney(angiomyolipoma), retroperitoneal LN enlargement, related with tuberous sclerosis (TSC-LAM)
.Radiographic findings
- generalized, symmetric, reticular or reticulonodular opacities
- preserved or increased lung volumes, pneumothorax, pleural effusion (secondary to chylothorax)
.CT findings
- Numerous thin-walled cysts surrounded by normal lung parenchyma with diffuse, random and bilateral distribution
- Cysts typically ranges from 2-5mm in diameter but have been reported to be as large as 25mm
- Round, polygonal and ovoid in shape
- Cyst wall thickness ranges from barely perceptable to 2mm thick in most cases

References
Keywords
Lung, Interstitial lung disease, LAM, ILD,

No. of Applicants : 117

▶ Correct Answer : 97/117,  82.9%
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Mie-chuo hosp. , Japan Hitoshi KODERA
  • - Osaka University , Japan Osamu Honda
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - seoul national university hospital , Korea (South) Ijin Joo
  • - kobe city general hospital , Japan rintaro hashimoto
  • - Goa Medical College , India Paresh Desai
  • - Okayama University , Japan Akihiro Tada
  • - radiologist, aditya imaging centre , India vivek patel
  • - Assam Medical college , India samudra borah
  • - Virgin Mary Hospital Burgas , Bulgaria VLADISLAV RUSINOV
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - IPGMER , India kanchan mishra
  • - Okayama university , Japan Takeharu Yamamoto
  • - University of British Columbia , Canada Amr Ajlan
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Onomichi municipal hospital , Japan Junya Itakura
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Chonbuk National University Hospital , Korea (South) Jisoo Song
  • - Chonnam university hospital , Korea (South) Minyoung Jung
  • - chest hospital , India k bhaskar
  • - Kasturba Medical College , India Chandan Kakkar
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Montreal , Canada D J
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - NEPEAN HOSPITAL , Australia YOGESH THAKKAR
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - KHOO TECK PUAT HOSPITAL , Singapore SUMER SHIKHARE
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - Retd. Prof Thoracic Surgery B.J.MEDIDCAL COLLEGE Punr India;Visitng Prof of Thoracic Surgery KLE University Belgaum , India Bankim Amin
  • - McGill University , Canada Ben Smith
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Saga University , Japan Ryoko Egashira
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - KRRS , Korea (South) usb
  • - Chonbuk National University Hospital , Korea (South) Sungkwan Kim
  • - KOREA UNIVERSITY ANSAN HOSPITAL , Korea (South) SEUNAH LEE
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - G.R. Medical College, Gwalior , India Rajesh Pillai
  • - IMS, BHU,VARANASI , India Sriram Patwari
  • - McGill , Canada Marcus Povitz
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Marseille APHM , France, Metropolitan Fabien Craighero
  • - nanjing medical university , China liu hui
  • - Dongnam Institute of Radiological and Medical Sciences , Korea (South) Dae Wook Yeh
  • - Seoul Nationial University Bundang Hospital , Korea (South) Hee Seok Choi
  • - Godeok health care substation , Korea (South) Jaewang Shin
  • - DrRP GMEDICAL COLLEGE TANDA , India DINESH SOOD
  • - PRIVATE PRACTITIONER , India BALA SWAMY
  • - CHRU LILLE , France Vittorio Pansini
  • - EKH-Berlin , Germany Michael Weber
  • - assam medical college , India aparimita g
  • - SHANDONG UNIVERSITY QILU HOSPITAL , China WEI CONROY
  • - Hospital M�e de Deus , Brazil Thiago Bento da Silva
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Chonnam national university hosipital , Korea (South) Byung chan Lee
  • - Chonnam National University , Korea (South) se hee Jung
  • - Louisiana State University - Shreveport , United States Carlos Previgliano
  • - SMC , Korea (South) Jihoon Cha
  • - clinique medipole toulouse , France delaunay francois
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - NTUH , Taiwan Kuei-pin Chung
  • - NDMVP Nashik , India Imran Jindani
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Vikram hospital , India Pravin Mahadevappa
  • - SNUH , Korea (South) Eun Sun LEE
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - Kobe City Medical Center General Hospital , Japan Hitomi Nagano
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Eulji university hospital , Korea (South) Hun-cheol lim
  • - IRSA , France jean-luc BIGOT
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - LES SORBIERS , France WAGNER odile
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - jobless , France jean-baptiste Noel
  • - All India Institute of medical sciences , India Justin Moses
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - NASA SCANS , India RAKESH BHATIA
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - chp st martin , France Mariotte benoit
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Chonnam university hospital , Korea (South) LEE HYUN
  • - Pneumology GHSR , Reunion fabrice paganin
  • - KUMC ansan , Korea (South) kihwan kim
  • - Okayama university , Japan Mayu Uka
  • - Shree Diagnostics , India amol jagdale
▶ Correct Answer as Differential Diagnosis : 9/117,  7.7%
  • - Hospital S�o Paulo , Brazil Rogerio Pinetti
  • - TRAKYA �N�VERS�TES� TIP FAK�LTES� , Turkey �A�LAYAN �AKIR
  • - royal melbourne hospital , Australia kimchi kings
  • - ALHAYAH SCAN RADIOLOGY CENTER , Egypt Elsayed Mousa
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - chonnam university hospital , Korea (South) shin hyo hyun
  • - UZ GASTHUISBERG , Belgium Johan COOLEN
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
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