Caceres’ Corner: Case No.11 (Update: Solution)


Dear friends,

Muppet saw this case three weeks ago. Clinical history was: 36-year-old woman hairdresser, pre-op chest.

Diagnosis:

1. Sarcoidosis
2. Extrinsic allergic pneumonitis
3. Lymphangitic carcinomatosis
4. Histiocytosis X

36 year old woman, PA chest

36 year old woman, PA chest

Click here for the answer to case #11

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23
Jan 2012
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DISCUSSION 31 Comments

31 Responses to : Caceres’ Corner: Case No.11 (Update: Solution)

  1. Lola la piconera says:

    1. Sarcoidosis.
    Is the patient asymptomatic? I´ve assumed she is.

    • Jose Caceres says:

      Muppet did not have any other clinical information at the time of the reading. He made the diagnosis, though.

  2. Albert says:

    Predominantly lower affection, the central venous catheter (by the way, abnormally positioned in a suprahepatic vein )…
    I would choose Lymphangitic carcinomatosis.

  3. Albert says:

    Anyway, I think Pulmonary thesaurismosis induced by inhalation of hair lacqer is extremely rare…but the patient occupation must be an important fact… Mustn’t it Muppet?

  4. girish kulkarni says:

    -reticulonodular opacities involving bilateral mid and lower zones

    -no significant volume loss

    -suggestion of right paratracheal adenopathy

    findings consistent with interstitial lung disease

    extrinsic allergic alveolitis and lymphngitis carcinomatosa are top differentials.sparing of upper zones is unlikely in extrinsic allergic alveolitis(only 10%) but occupation makes it likely.

    lymphangitis is likely on the basis of central peribronchovascular thickening and nodules,but needs appropriate clinical setting.

    HRCT chest for furthur evaluation

  5. ahmed says:

    Extrinsic allergic pneumonitis

  6. Z says:

    Extrinsic allergic pneumonitis. This distribution can be seen early (within hours of exposure). Chronic exposure has an upper and mid zone distribution.

  7. Nikhil M says:

    Lymphangitic carcinomatosis

  8. Maria F says:

    Pre-Op for what? Operation involving her left breast maybe (Ca)?
    I will go with lymphagitic carcinomatosis with irregular thickening of septa specially in the middle lobe, assymetric, preserved lung volumes and hilar adenopathy.

    Sarcoidosis predominates in mid/upper zones
    Langherhans Cell Hystiocytosis usually spares bases and is a mid to upper lobe disease

  9. Olgi says:

    Extrinsic allergic pneumonitis

  10. Anna says:

    Hello Mr. Muppet, does she smoke? If so, then as usual I vote for four 😉

  11. Vilma says:

    mmm… lymphangitic carcinomatosis :/

  12. rvinay says:

    lymphantic carcinomatosis

  13. aca says:

    lymphangiitis Ca/Ovarian Cancer,i had a same story patient before a few years…chronic exposure of chemical substances for hair colouring was a couse of it…so,women,take good care when you go to colour your hair 🙂

  14. nafkor says:

    3……or 2!

  15. Laura says:

    Histiocytosis x

  16. faidra says:

    does muppet see any changes in the bones?

    • Jose Caceres says:

      Muppet does not see any bone changes. But lately he is not himself. I am considering getting himm a seeing-eye dog!

  17. abdalllah says:

    Extrinsic allergic pneumonitis

    retculonodular pattern
    no rt paratracheal lymph nodes.

  18. NAR says:

    3. Lymphangitic carcinomatosis

  19. hoyam baderaldeen says:

    there normal lung volumes normal lung volumes there is hilar lymph nodes i think this lymphangitis carcinomatosis ,extrinsic allergic pneumnitis and histiocytosis x affect upper lobe most probably

  20. hoyam baderaldeen says:

    there is no hilar lymphadenopathy

  21. Sarbesh Tiwari says:

    extrinsic allergic pneumonitis

  22. Adela Montelongo Martín says:

    Lymphangitic carcinomatosis

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