José Vilar and Friends Case 2 (Update: Solution!)

Dear friends,

Thank you for joining. The last case was a warm up. This one is a little bit more complicated but I know that you will be able to help me with the diagnosis.

This is a 54 year old woman with long standing renal disease.

What do you think?

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


Click here for the answer

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    Jan 2019
    DISCUSSION 12 Comments

    12 Responses to : José Vilar and Friends Case 2 (Update: Solution!)

    1. M Venkatesh says:

      Multiple reticulonodular tiny opacities with few bony sclerotic lesions and enlarged cystic kidneys – Aquired cystic renal disease with infectious bronchiolitis

    2. MV says:

      Small difuse dense (calcified) nodules in a patient with polycystic renal disesae, osteopenia and rugger-jersey spine. no evidence of lymphadenopathy.
      I would go for metastatic pulmonary calcification and renal osteodystrophy. Milliary calcifications are also possible. TB milliary disesae is less likely in the abscence of adenopathy.

    3. Shaimaa says:

      Multiple centrilobular nodules

    4. nb says:

      Pulmonary oedema and pulmonary hypertension due to renal failure

    5. Moose says:

      Multiple centrilobular nodules without lobar predilection. Mild subpleural sparing. Enlarged kidneys containing multiple cysts.
      Has there been a renal transplant? Subacute hypersensitivity pneumonitis secondary to immunosuppressant medication?

    6. MK says:

      Good morning!

      In the x-ray and CT there are multiple bilateral, diffuse and randomly distributed micronodules. In the osseous window there are some blastic lesions and in the abdomen there is a policystic renal disease. I am thinking about hyperparathyroidism.

    7. tr says:

      on the CXR, a coarse reticulonodular pattern can be seen without volume loss, which was confirmed by CT, the kidneys appearance is consistent with autosomal dominant polycystic kidney disease.

      considering the history and radiographic appearance I would consider a drug-induced interstitial lung disease.

    8. jose vilar says:

      You guys are getting close but not completely. The case is quite difficult as you will soon se, but I believe that theres is a teaching clue…

    9. Mauro says:

      Probably the lung and bone changes can be explained by amyloidosis secondary to the chronic kidney disease.

    10. jose vilar says:

      Look at the bone window settings in the chest CT. Does it help?

    11. Nadia says:

      I was wondering… would it be possible to get another images with bone windowing? I am not quite sure what we can see in this one. It looks like multiple small sclerotic lesions that are found in patients with tuberous sclerosis, however, with one scan only I do not feel very confident about this differential.

      Thank you 🙂

    12. Andra says:

      on the thoracic X-ray and CT there are multiples multifocal micronodules centrolobulaires.In bone window some sclerotic bone lesions. In the abdomen there is an aspect of polycystic kidney disease. I think of tuberous sclerosis.