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Weekly Chest CasesArchive of Old Cases

Case No : 1449 Date 2025-07-28

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  • Courtesy of Yeon Joo Jeong, / Pusan National University Yangsan Hospital
  • Age/Sex 73 / M
  • Chief ComplaintBrown urine, incidentally detected abnormality on chest CT for genitourinary disease work-up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
IgG4-Related Disease
Radiologic Findings
Figs 1-3. Lung window images of contrast-enhanced chest CT scans show multiple irregular shaped subpleural lung nodules in both lungs, along with subpleural patchy ground glass opacities in both lower lobes.
Figs 4 and 5. Mediastinal window images of contrast-enhanced chest CT scans show mildly enlarged upper paratracheal and right hilar lymph nodes.
Brief Review
Upper abdominal CT revealed a diffusely enlarged pancreas with peripancreatic fluid, suggestive of pancreatitis. Considering both chest and upper abdominal CT findings, IgG4-related disease (IgG4-RD) was highly suspected. The patient's serum IgG4 level was elevated to 1234 mg/dL (normal range: 3.9
References
1. Stone JH et al. IgG4-related disease. N Engl J Med. 2012;366:539-551.
2. Muller R et al. Thoracic manifestations of IgG4-related disease. Respirology 2023; 28:120-131
Keywords

No. of Applicants : 66

▶ Correct Answer : 9/66,  13.6%
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Teikyo University Hospital , Japan CHIAKI SATO
  • - , Korea (South) DAWON PARK
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
▶ Correct Answer as Differential Diagnosis : 18/66,  27.3%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - , Italy PAOLO BALDASSARI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Osaka University , Japan AKINORI HATA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Kyoto University , Japan SHO KOYASU
  • - Kobe Children , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - Ehime University , Japan TOMOHISA OKADA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - , Japan JUN YOSHIDA
  • - Jiangsu province hospital , China WANGJIAN ZHA
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Current Editor : Eui Jin Hwang, M.D., Ph.D Email : weeklychestcases@gmail.com

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