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.


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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    Jan 2012
    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