This week’s #RadiologyRounds is coming from the pulmonary clinic. Follow us on Twitter to see the case and answer our polls live!
Given the patient’s weight loss and persistent symptoms despite trying some empiric therapies, a chest CT was obtained. PFTs were also ordered 🙂
The patient’s CT had tree-in-bud opacities, nodular consolidations, scattered micronodular opacities, and airway thickening.
The pt had an induced sputum but could not produce a sample. She underwent bronchoscopy + lavage and her AFB smear was positive with negative TB NAAT. The culture ended up growing M. chimaera! Does that explain her symptoms? Here are the diagnostic criteria for pulmonary NTM:
All other testing was negative and the patient was diagnosed with pulmonary NTM. After a long discussion about treatment (an interesting topic for another day!!) she was started on triple antibiotic therapy and after 9 months her cough had resolved and she was gaining weight.
For #RadiologyRounds this week we have a mystery case from the pulmonary clinic complete with imaging and exploration of PFTs. Follow along for some great clinical pearls and teaching points about lung function tests. Graphics made with the help of outstanding educator Kaitlin Seitz.
What imaging views would you get next?
A) Supine and prone
B) Inspiratory and expiratory
C) High resolution
D) With contrast
What test would you get next?
D) Lung US
What do these PFTs show?
A) Restriction concerning for ILD
B) Restriction concerning for obesity
C) Restriction concerning for weakness
D) Mixed obstruction and restriction
The patient was referred to neurology and ultimately diagnosed with severe mixed sensory and motor chronic axonal polyneuropathy.
This week’s #RadiologyRounds and tutorial is authored by Huzaifah Salat, our newest PulmPEEPs contributor! See if you can figure out the case and check out our high-yield points at the end. Follow us on Twitter to answer live polls about the case.
It is Tuesday and we have another Radiology Rounds we can’t wait to share with you. Follow along and see if you select the right answer as we go through different presentations of sarcoidosis and pick your answer! What stage is it?!
A middle-aged man presents to you after he was found to have hilar adenopathy on a routine chest x-ray.
A middle-age man presents with dyspnea on exertion, night sweats and weight loss. You see evidence of bilateral apical disease, and fibrosis with evidence of honeycombing on chest CT.
A young woman presents with dyspnea on exertion and was found to have hilar adenopathy with parenchymal disease.
An elderly man presents with dyspnea on exertion and was found to have nodular parenchymal disease without extensive lymphadenopathy.
It is Tuesday and time for another #RadiologyRounds!! This is a patient who presented to the emergency department with symptoms of cough, dyspnea, malaise, and weight loss. A PA and lateral CXR was obtained.
Time for another #RadiologyRounds!! This week we’re looking at the coronal CT scan views, which can be extremely helpful and are often under-utilized. Follow us on Twitter to work through Radiology Rounds cases as they come out.
Our patient had an elevated VEGF-D level, a renal angiomyolipoma identified on CT abdomen, and imaging with diffuse cystic lung disease confirming her diagnosis of LAM. Make sure to check out the ICUOnePager made by Dr. Nick Mark.
This week’s #RadiologyRounds is brought to you by our newest Contributor, Matthew Tsai! Matt will be continuing to work with us to bring you great cases and images and we are thrilled to have him on the team! Follow us on Twitter and Instagram for our Radiology Rounds, podcast episode releases, and more!
What abnormalities do you see on this CXR to help explain the patient’s presentation?
The CT scan has reticular changes consistent with interstitial lung disease and there are multiple features that help us define the pattern of the ILD. His CT notably has very few ground-glass opacities, there is traction bronchiectasis, and honeycombing with a basilar and peripheral / sub-pleural predominance.
Taking all these features together, the patient’s radiographic presentation is consistent with Usual Interstitial Pneumonia (UIP)
This patient had a thorough history taken and he had no prior smoking and no occupational or environmental exposures of significance. He had no family history of interstitial lung disease. A broad history was taken regarding symptoms of connective tissue disease and a broad serologic workup was sent, all of which were unremarkable. What would you want to do next diagnostically?