Case 1

List the abnormalities in this CXR?           

Answer

Case 1 answer

• Right upper lobe disease
• Wedge shaped density
• Anterior segment
• Air bronchogram
• Full right hilum

Patient presents with refractory cough of 3 months duration. Non smoker. No fever or weight loss.

What is the Radiological pattern? What is your differential for this pattern?

Answer

Case 1 answer

Chronic alveolar infiltrate

• Segmental density
• Soft fluffy edges
• Air bronchogram

Etiological considerations for localized chronic alveolar disease

• Tuberculosis
• Alveolar form of Lymphoma
• Alveolar form of Sarcoidosis
• Alveolar cell carcinoma
• Lipoid pneumonia

Post obstructive Pneumonia will not last for 3 months without some volume loss.

What is your primary consideration?

Answer.

Case1 answer

Location makes Lipoid pneumonia and Tuberculosis less likely.

This patient had Alveolar cell carcinoma.

What are the clinical modes of presentation of alveolar cell carcinoma. How would you classify this CXR?

Answer

Case1 answer

• Solitary pulmonary nodule
• Pneumonic form
• Multicentric variety

This patient had Pneumonic form. Management decisions are based on this classification. Look up how to take care of each mode of presentation.

Micro : Note how the cancer cells line up the scaffolding of alveolus.

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