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Sarcoidosis

Brewer MDB - MedPix (2009)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Sarcoidosis

History: 68yo M with history of asbestos exposure presents with 10lb weight loss over 2 mo. No cough.

Findings: CXR 1Nov2005 FINDINGS: There is adequate inflation bilaterally. No mass, effusion or pneumothorax is visualized. Tortuosity of the aorta and degenerative changes of the thoracic spine once again noted. Cardiac silhouette is normal in size and contour. No pulmonary vascular congestion. IMPRESSION: 1. No acute cardiopulmonary disease. 2. Senescent changes of the aorta and thoracic spine. D: 02 NOV 05 T: 05 NOV 05 06337.mlp.tae CXR 20Nov2008 FINDINGS: There has been interval development of diffuse interstitial lung markings bilaterally predominantly upper lobes. A reticular nodular component is suspected. No focal masses are identified. There is no evidence of pleural effusion or pneumothorax. Mild biapical pleural thickening is seen. Cardiomediastinal silhouette is within normal limits and the osseous structures are unremarkable. IMPRESSION: Interval development of interstitial lung markings predominantly upper lobes in a reticular nodular pattern. A CT of the chest is recommended for further evaluation. Chest CT 24Nov2008 FINDINGS: There are multiple micronodules visualized predominantly in the upper lobes and superior segments of the lower lobes. The nodules have a predominantly perilymphatic and subpleural distribution. There is also upper lobe peribronchovascular fibrosis and thickening. Mild bronchiolatelectasis is present in the upper lobes as well. Subpleural pseudoplaques are also visualized predominantly in the left upper lobe. Several subcentimeter prevascular, AP window, paratracheal, precarinal, and subcarinal lymph nodes are visualized. None of the lymph nodes appear to be calcified. On the expiratory images, there is minimal air trapping in the lung bases suggestive of some small airways disease. In the right lower lobe, there is a subpleural area of increased reticular markings adjacent to marginal osteophytes along the thoracic spine. Limited evaluation of the hollow and visceral structures of the upper abdomen is unremarkable. Multilevel discogenic degenerative changes along the thoracic spine with no suspicious osteoblastic or osteolytic lesions. IMPRESSION: Multiple perilymphatic and subpleural nodules primarily in an upper lobe and perihilar distribution with associated thickening of the bronchovascular bundles. Differential considerations include sarcoidosis and silicosis. A concomitant superimposed granulomatous infection and lymphangitic carcinomatosis are also possible but less likely given the fact that the pulmonary findings are predominantly in an upper lobe and perilymphatic distribution. A pulmonary consult and subsequent follow up CT examinations are recommended after appropriate therapy is initiated. CXR 15Dec2008 The lungs are adequately inflated. No pneumothorax. Stable diffusely increased interstitial lung markings primarily in the upper lobes. No new airspace disease. No pleural effusion. Normal cardiac silhouette. Stable senescent changes of the thoracic aorta. Pulmonary vasculature is normal. Stable degenerative changes of the thoracic spine. Soft tissues are without abnormality. Impression: Stable increased lung markings in the upper lobes predominantly with reticulonodular pattern suggestive of sarcoidosis, inflammatory granulomatous, or infectious granulomatous diseases.

No MeSH data available.


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Sarcoidosis

Brewer MDB - MedPix (2009)

© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1281&req=5

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Sarcoidosis

History: 68yo M with history of asbestos exposure presents with 10lb weight loss over 2 mo. No cough.

Findings: CXR 1Nov2005 FINDINGS: There is adequate inflation bilaterally. No mass, effusion or pneumothorax is visualized. Tortuosity of the aorta and degenerative changes of the thoracic spine once again noted. Cardiac silhouette is normal in size and contour. No pulmonary vascular congestion. IMPRESSION: 1. No acute cardiopulmonary disease. 2. Senescent changes of the aorta and thoracic spine. D: 02 NOV 05 T: 05 NOV 05 06337.mlp.tae CXR 20Nov2008 FINDINGS: There has been interval development of diffuse interstitial lung markings bilaterally predominantly upper lobes. A reticular nodular component is suspected. No focal masses are identified. There is no evidence of pleural effusion or pneumothorax. Mild biapical pleural thickening is seen. Cardiomediastinal silhouette is within normal limits and the osseous structures are unremarkable. IMPRESSION: Interval development of interstitial lung markings predominantly upper lobes in a reticular nodular pattern. A CT of the chest is recommended for further evaluation. Chest CT 24Nov2008 FINDINGS: There are multiple micronodules visualized predominantly in the upper lobes and superior segments of the lower lobes. The nodules have a predominantly perilymphatic and subpleural distribution. There is also upper lobe peribronchovascular fibrosis and thickening. Mild bronchiolatelectasis is present in the upper lobes as well. Subpleural pseudoplaques are also visualized predominantly in the left upper lobe. Several subcentimeter prevascular, AP window, paratracheal, precarinal, and subcarinal lymph nodes are visualized. None of the lymph nodes appear to be calcified. On the expiratory images, there is minimal air trapping in the lung bases suggestive of some small airways disease. In the right lower lobe, there is a subpleural area of increased reticular markings adjacent to marginal osteophytes along the thoracic spine. Limited evaluation of the hollow and visceral structures of the upper abdomen is unremarkable. Multilevel discogenic degenerative changes along the thoracic spine with no suspicious osteoblastic or osteolytic lesions. IMPRESSION: Multiple perilymphatic and subpleural nodules primarily in an upper lobe and perihilar distribution with associated thickening of the bronchovascular bundles. Differential considerations include sarcoidosis and silicosis. A concomitant superimposed granulomatous infection and lymphangitic carcinomatosis are also possible but less likely given the fact that the pulmonary findings are predominantly in an upper lobe and perilymphatic distribution. A pulmonary consult and subsequent follow up CT examinations are recommended after appropriate therapy is initiated. CXR 15Dec2008 The lungs are adequately inflated. No pneumothorax. Stable diffusely increased interstitial lung markings primarily in the upper lobes. No new airspace disease. No pleural effusion. Normal cardiac silhouette. Stable senescent changes of the thoracic aorta. Pulmonary vasculature is normal. Stable degenerative changes of the thoracic spine. Soft tissues are without abnormality. Impression: Stable increased lung markings in the upper lobes predominantly with reticulonodular pattern suggestive of sarcoidosis, inflammatory granulomatous, or infectious granulomatous diseases.

No MeSH data available.