Dr. Pepe’s Diploma Casebook: Case 97 – A painless approach to interpretation (Chapter 4) – SOLVED!


Dear Friends,

Now that we’ve looked at the three key questions to ask when facing a chest radiograph (chapters 1, 2 and 3), we move on to the interpretation of pulmonary lesions.

Today I am showing chest radiographs of a 31-year-old woman with marked dyspnoea for the last three days.

What would you call the predominant pattern?

1. Reticulonodular
2. Septal
3. Air-space disease
4. None of the above

Check the images below, leave your thoughts in the comments and come back on Friday for the answer.



Click here for the answer

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    15 Responses to : Dr. Pepe’s Diploma Casebook: Case 97 – A painless approach to interpretation (Chapter 4) – SOLVED!

    1. Mahmoud says:

      Reticulonodular pattern

    2. MK says:

      Cardiac size is in the normality´s high limit.
      There is a reticulo-nodular pattern predominantly on the inferior lobules, with a micronodular thickened of the cissures.

      Any medical personal hystory of interest?

      Carcinomatosis lymphangitis must be considerated.

    3. Mauro says:

      Reticulonodular pattern. Probably due to lymphangitic carcinomatosis.

    4. Andrea Fuentealba Cargill says:

      Reticulonodular pattern

    5. Mahmoud says:

      Both lung volumes are preserved or mildly increased, along with the bilateral reticulonodular pattern in young female, LAM should be considered.

    6. Teresa says:

      Reticulonodular pattern

    7. Yvette says:

      Reticulonodular pattern in both lungs. Distribution is almost even in upper and lower part of the lungs. Mediastinum and both hilum are normalnie size. No pleural effusion. Young woman in child bearing age indicates on LAM. Langerhans histiocytosis less probable. Usually in heavy smokers, older and costophrenic angles are usually preserved. Limphangitis carcinomatosis should be always take into consideration.

    8. DrPedro says:

      – Septal pattern- Kerley lines- pulmonary interstitial edema
      – Ill-defined pulmonary nodules in the lower lungs- haemosiderosis
      – Thickened fissures- subpleural edema
      – Double right heart border- enlarged left atrium
      – Cephalization
      – Right pleural effusion- posterior costo-phrenic angle

      Congestive heart failure- Mitral stenosis

    9. Mahmoud says:

      I’d like to ask if the patient have AIDS?
      If yes, PCP should be considered
      If not , I’m still with LAM.

    10. genchi bari italia says:

      ….Stimatissimo professore…..il pattern x-grafico è quello micronodulare, prevalente alle basi….si associa a lieve quota di versamento pleurico e congestione vascolare….il soggetto è giovane , non fuma, non ha adenopatie ilo-mediastiniche, pertanto dovrebbero escludersi la TBC, la bronchiolite del fumatore, l’istiocitosi iniziale,le metastasi….potrebbe essere la forma subacuta di una alveolite allergica estrinseca(anamnesi anche lavorativa)….

    11. Arafat says:

      Bilateral reticulo-nodular interstitial pattern, more towards bi-basal regions – Usual Interstitial pneumonia

      Other DD: Lymphangitic carcinomatosis

    12. Mk says:

      Perhaps the predominant pattern is reticulo-nodular, but with alveolar filled disease in inferior lobules

    13. Jose Caceres says:

      Would like to make a short comment. In my opinion, patterns are meant to shorten the diagnostic options. In this case, recognizing Kerley lines limits the diagnosis to two main options: interstitial edema vs. lymphangitic carcinomatosis. The first option is the most likely one in an acutelly ill patient.
      Congratulations to DrPedro, who made an accurate interpretation