José Vilar and Friends Case 42 (Update: Additional Images!)

Dear friends,

We embark today in a case less focused in finding a radiologic sign and more in a clinical context, but, of course from the imaging point of view.

This case provided to me by Dr Ruben Ruiz, a senior resident and Dr Santiago Isarría already known in this blog, both from Hospital Universitario Dr. Peset in Valencia. Spain.

This is a 52-year-old woman with Lupus erythematosus and a history of cervical cancer treated with radiation therapy.

The lady complains of right chest pain at deep inspiration.

Previous Chest radiograph seven months before

What do you think? Please give me a differential diagnosis and I will provide you later with additional images.


Update: Additional Images

Here are some CT images. Although tuberculosis was suspected this was discarded after a thorough investigation.

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    Feb 2021
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    DISCUSSION 6 Comments

    6 Responses to : José Vilar and Friends Case 42 (Update: Additional Images!)

    1. Marcos Mestas says:

      Upper lobe consolidation with some radiolucencies and volume loss. It could be radiation induce lung fibrosis but also an infection cause, more if is recieving inmune suppressive treatment like a tuberculosis reactivation with cavitation.
      The third a usual lobar pmeumonia in a fibrotic upper lobe because of the radiotherapy

    2. Marcos Mestas says:

      I just saw that 7 month earlier the upper lobe seems ok. So my first choice is tuberculosis

    3. DR..KANNAN KANAKARAJ says:

      THERE IS PARENCHYMAL FIBROSIS, WITH SMALL CYSTIC LUCENCIES AND PLEURAL THICKENING CONFINED TO THE RIGHT UPPER ZONE- CONSISTENT WITH RADIATION PNEUMONITIS, FIBROSIS AND PLEURAL THICKENING.
      THE RIGHT HILUM IS NORMAL- NOT ELEVATED, NOR ANY HILAR NODES OR MASS TO SUGGEST TOTAL RIGHT UPPER LOBE INVOLVEMENT.
      THE REST OF THE LUNG FIELDS AND COSTOPHRENIC ANGLES ARE NORMAL.
      THE PATHOLOGY CONFINES TO THE RADIATION PORT OR AREA ONLY

    4. Anastasia Doukopoulou says:

      Consolidation with radiolucent areas located at the apical segment of the right upper lobe. The right hilum & the horizontal fissure are pulled towards the lesion. I would probably say that there is also peribronchial fibrosis.
      It could be necrotizing pneumonia, pulmonary tuberculosis or necrotizing bronchopulmonary aspergillosis.

    5. José Vilar says:

      Ok. Most of you are in the right track. I am going to add some more images and I will then expect a diagnosis.

    6. Marcos Mestas says:

      Aspergillus?

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