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

1. Lola la piconera says:

   January 23, 2012 at 18:42

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

   • Jose Caceres says:

     January 23, 2012 at 19:06

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

2. Albert says:

   January 23, 2012 at 22:53

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

   • Jose Caceres says:

     January 25, 2012 at 07:19

     Congratulations. You are the ony one that mentioned the catheter.

3. Albert says:

   January 23, 2012 at 23:54

   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?

   • Jose Caceres says:

     January 24, 2012 at 06:59

     Muppet is a simple fellow. He thinks thesaurismosis is the name of a Pharaoh.

     • Anna says:

       January 24, 2012 at 23:13

       or a dinosaur 😉

4. girish kulkarni says:

   January 24, 2012 at 16:29

   -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

   • Jose Caceres says:

     January 26, 2012 at 17:10

     Muppet’s too smart. He uses HRCT for really difficult cases.

5. ahmed says:

   January 24, 2012 at 18:06

   Extrinsic allergic pneumonitis

6. Z says:

   January 24, 2012 at 18:34

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

7. Petite says:

   January 24, 2012 at 19:10

   4.

8. Nikhil M says:

   January 24, 2012 at 19:11

   Lymphangitic carcinomatosis

9. Maria F says:

   January 24, 2012 at 19:17

   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

10. Olgi says:

    January 24, 2012 at 21:19

    Extrinsic allergic pneumonitis

11. Anna says:

    January 24, 2012 at 23:11

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

12. Vilma says:

    January 24, 2012 at 23:36

    mmm… lymphangitic carcinomatosis :/

13. rvinay says:

    January 25, 2012 at 06:27

    lymphantic carcinomatosis

14. aca says:

    January 25, 2012 at 18:27

    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 🙂

15. amutha says:

    January 30, 2012 at 19:53

    3

16. nafkor says:

    January 31, 2012 at 11:18

    3……or 2!

    • Jose Caceres says:

      February 1, 2012 at 16:42

      Patterns of both are different. You have to choose.

17. Laura says:

    January 31, 2012 at 13:33

    Histiocytosis x

18. faidra says:

    January 31, 2012 at 21:15

    does muppet see any changes in the bones?

    • Jose Caceres says:

      February 1, 2012 at 16:43

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

19. abdalllah says:

    January 31, 2012 at 21:53

    Extrinsic allergic pneumonitis

    retculonodular pattern
    no rt paratracheal lymph nodes.

20. NAR says:

    February 2, 2012 at 09:36

    3. Lymphangitic carcinomatosis

21. hoyam baderaldeen says:

    February 4, 2012 at 18:18

    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

22. hoyam baderaldeen says:

    February 4, 2012 at 18:23

    there is no hilar lymphadenopathy

23. Sarbesh Tiwari says:

    February 6, 2012 at 16:43

    extrinsic allergic pneumonitis

24. Adela Montelongo Martín says:

    February 7, 2012 at 18:05

    Lymphangitic carcinomatosis