Chronic & ILD – ChestDB.com

Case 35

Chronic & ILD, Mediastinum / Age <30, Eisenmenger Syndrome, Pulmonary Hypertension, Shunt

This radiograph shows severely dilated pulmonary arteries. The differential for this finding includes pulmonary hypertension, flow abnormalities from shunting or valvular disease, and connective tissue diseases, among others. This a young patient with Eisenmenger Syndrome, a condition resulting from a longstanding uncorrected left-to-right shunt. The shunt causes pulmonary hypertension, which eventually becomes so severe that the direction of flow through the shunt reverses resulting in significant hypoxemia.

The exam is otherwise normal.

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Case 31

Chronic & ILD, Infectious/Inflammatory / Age 31-60, Calcification, Histoplasmosis, Nodule

This radiograph demonstrates multiple bilateral calcified pulmonary nodules and hilar lymph nodes. The most common cause of this finding by far is granuloma formation secondary to healed infection. The calcifications typically do not resolve, but are of no clinical consequence. The infection in many cases is mild or subclinical. In areas of the United States where Histoplasma capsulatum is endemic, it is common to have one or more calcified granulomas without a history of significant infection. In this case, the patient did report a history of histoplasmosis. The exam is otherwise unremarkable.

The differential includes calcified metastasis (such as from osteosarcoma), nodular sarcoidosis, and miliary TB among others, though these are significantly less common.

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Case 28

Chronic & ILD / Age 31-60, Albers-Schönberg Disease, Fracture, Marble Bone Disease, Osteopetrosis, Portable

This radiograph demonstrates osteopetrosis (also known as marble bone disease and Albers-Schönberg disease), a disorder of osteoclasts which leads to unopposed osteoblastic activity. The bones are diffusely thickened and sclerotic. Multiple rib fractures are noted, highlighting the fragility of the disorganized bone.

The lungs and mediastinum are unremarkable.

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Case 21

Chronic & ILD, Lines/Tubes/Devices / Age >61, Atelectasis (Lobar), COPD, Emphysema, Endobronchial Valve, Eventration, Hiatal Hernia, Luftsichel Sign

This radiograph demonstrates several findings:

First, this is a COPD patient with very few lung markings seen in the right upper lobe due to severe emphysema.

Second, this patient has undergone endobronchial valve placement leading to complete lobar atelectasis in the left upper lobe. The valves themselves are visible projecting over the left hilum. There is expected volume loss in the left hemithorax, with increased opacity in the left lung due to superimposition of the collapsed left upper lobe and aerated left lower lobe.

Third, a named sign is demonstrated: The luftsichel sign (German for “air crescent”), which is seen as a crescentic lucency in the paramedian left upper lung and indicates left upper lobe collapse. The lucency is created by a portion of the aerated left lower lobe that insinuates itself between the mediastinal wall and the collapsed upper lobe.

Fourth, there is an incidentally noted small hiatal hernia seen as a rounded opacity projecting just to the left of midline at the level of the diaphragm. Diaphragmatic eventration is also noted.

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Case 20

Chronic & ILD / Age 31-60, Bronchiectasis, Cystic Fibrosis, Port

This radiograph demonstrates severe cylindrical bronchiectasis, also referred to as tubular bronchiectasis, in an adult patient with cystic fibrosis. This patient has symmetric upper lobe disease which is a common pattern in this condition, though other distributions are not uncommon.

An implanted port is also seen with the tip terminating in the superior vena cava. The port reservoir is placed in the inferior chest wall in this patient, which is an unusual location.

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