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
The following findings are shown:
1- Multiple pulmonary nodules with a random distribution and few lung cysts (yellow arrows).
2- Large kidneys with multiple cysts
3- In the CT, Bone window settings small sclerotic areas are seen in the vertebrae. (red arrows)
Diagnosis: Multifocal pneumocyte hyperplasia in tuberous sclerosis
Comment: The patient had Tuberous sclerosis with renal cystic disease (no angiomyolipomas in this case). Pneumocyte hyperplasia occurs in tuberous sclerosis as another expression of the disease in with multiple hamartomas are present in different organs including bones (sclerotic lesions)-
Pneumocyte hyperplasia may coexist with lung cysts in some cases. IN our case there were few cysts (yellow arrows), but the nodular pattern was predominant.
Two teaching points:
1- Look at the bones when suspecting tuberous sclerosis.
2- Yes: multiple random pulmonary nodules may be present in Tuberous sclerosis.
