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Weekly Chest CasesArchive of Old Cases

Case No : 849 Date 2014-02-03

  • Courtesy of So Young Choi / Eulji University Hospital
  • Age/Sex 20 / M
  • Chief Complaintcough for 1 month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Langerhans cell histiocytosis
Radiologic Findings
Plain chest radiograph shows multiple ill-defined nodular opacities with subtle reticular opacities in both lungs.
Chest CT scan images show multiple tiny nodules, ill-defined cavitary nodules and air cysts in both lungs, with upper and mid- lung zone predominance.
VATS biopsy was done and pulmonary Langerhans cell histiocytosis was confirmed.
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. Patterns of the nodules or cysts may represent longevity of the lesions. 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. 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 717, Case 587, Case 422,
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
3. Brauner MW, Grenier P, Mouelhi MM, Mompoint D, Lenoir S. Pulmonary histiocytosis X: evaluation with HRCT. Radiology 1989;172:255-258
4. Moor ADA, Godwin DJ, Muller NL, et al. Pulmonary histiocytosis X: comparison of radiographic and CT findings. Radiology 1989;172:249-254
5. Webb WR, Muller NL, Naidich DP. High-resolution CT of the lung. 3rd. Lippincott Williams & Wilkins, 2001:421-429
Keywords
Lung, Interstitial lung disease, LCH, smoking related ILD,

No. of Applicants : 90

▶ Correct Answer : 46/90,  51.1%
  • - National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - radiologist, aditya imaging centre , India vivek patel
  • - Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
  • - University of British Columbia , Canada Amr Ajlan
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - university of montreal , Canada Andrei Gorgos I
  • - prince salman bin abdulaziz university , Saudi Arabia NABIL GHALEB
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - UZA , Belgium Eline De Smet
  • - Kyoto University , Japan Akihiko Sakata
  • - chp st martin , France Mariotte benoit
  • - Royal Perth Hospital , Australia Yuranga Weerakkody
  • - UZ Brussel , Belgium Abd Alla Fares
  • - McGill University Health Center , Canada Alexandre Semionov
  • - MBAL Chernomorska , Bulgaria VLADISLAV RUSINOV
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Korea University Guro Hospital , Korea (South) Jeong Woo Kim
  • - Hopital Bichat , France, Metropolitan Pauline Pradere
  • - Chonnam National University Hospital , Korea (South) Sungmin Moon
  • - CNUH , Korea (South) Kim Soo Hyun
  • - Suncheon Plus Medicine , Korea (South) Park Sang Hyun
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Ewha Womans University Mokdong Hospital , Korea (South) So Won Lee
  • - CHU Poitiers , France CHAN paul
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - UWO , Canada S Lee
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Asan Medical Center, Department of Radiology , Korea (South) Hongseok Ko
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Radiology Department, the First Affliated Hospital of Nanjing Medical University (Jiangsu province Hospital) , China Qiguang Cheng
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Teikyo University Mizonokuchi Hospital , Japan Kaoru Sumida
  • - CHU POITIERS , France SZTARK Guillaume
  • - GHOL, Hopital de Nyon , Switzerland Benoit Rizk
  • - Fukuyama City Hospital , Japan Mayu Uka
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
  • - TCM HOSPITAL OF ZIGONG , China Cao Cunyou
  • - kanto Rosai Hp , Japan Takana Yamakawa
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 8/90,  8.9%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Saint Malo , France jean-baptiste Noel
  • - All India Institute of medical sciences , India Justin Moses
  • - C.B.H. Dpt of Imaging-Clinica , Italy Carlo Florio
  • - Private sector , Greece Vasilios Tzilas
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